Healthcare Provider Details

I. General information

NPI: 1285449553
Provider Name (Legal Business Name): JOSIE HARRIS ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S WAKARA WAY
SALT LAKE CITY UT
84108-1200
US

IV. Provider business mailing address

1920 E SYLVAN AVE
SALT LAKE CITY UT
84108-3125
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-7109
  • Fax: 801-581-4068
Mailing address:
  • Phone: 801-946-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number11871244-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: