Healthcare Provider Details

I. General information

NPI: 1265251284
Provider Name (Legal Business Name): NATHAN STONE MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 N 300 W
SALT LAKE CITY UT
84103-1100
US

IV. Provider business mailing address

950 N CUTLER DR APT 828
NORTH SALT LAKE UT
84054-5056
US

V. Phone/Fax

Practice location:
  • Phone: 801-578-8500
  • Fax:
Mailing address:
  • Phone: 801-520-3584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number9838361-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: