Healthcare Provider Details

I. General information

NPI: 1013339332
Provider Name (Legal Business Name): JUSTIN RIGBY ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 E 250 S HPR-E, ROOM 208
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

1860 E 250 S HPR-E, ROOM 208
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-1820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number7886823-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: