Healthcare Provider Details

I. General information

NPI: 1659702918
Provider Name (Legal Business Name): JULIE MARIE WOOD MS, ATC, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 12/11/2013
Certification Date:
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

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

V. Phone/Fax

Practice location:
  • Phone: 801-587-7025
  • Fax: 801-587-7121
Mailing address:
  • Phone: 801-587-7025
  • Fax: 801-587-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number8739579-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: