Healthcare Provider Details

I. General information

NPI: 1821487885
Provider Name (Legal Business Name): KATHERINE HUGHES ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 E SOUTHCAMPUS DR
SALT LAKE CITY UT
84112-0900
US

IV. Provider business mailing address

701 N DE SOTO ST
SALT LAKE CITY UT
84103-2138
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-9085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number8689217-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: