Healthcare Provider Details

I. General information

NPI: 1467680835
Provider Name (Legal Business Name): LAUREN ZIAKS DPT, ATC, AIB-VR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 12/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ROUND VALLEY DR
PARK CITY UT
84060-7552
US

IV. Provider business mailing address

900 ROUND VALLEY DR
PARK CITY UT
84060-7552
US

V. Phone/Fax

Practice location:
  • Phone: 435-658-7350
  • Fax:
Mailing address:
  • Phone: 435-658-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8324399-8016
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number01997
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number8324399-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: