Healthcare Provider Details

I. General information

NPI: 1164201083
Provider Name (Legal Business Name): RACHEL CALLISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 N 300 W STE 301
PROVO UT
84604-6124
US

IV. Provider business mailing address

907 E 600 N
OREM UT
84097-4219
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-1200
  • Fax: 801-357-1239
Mailing address:
  • Phone: 801-922-0943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number14232216-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: