Healthcare Provider Details

I. General information

NPI: 1497377972
Provider Name (Legal Business Name): SOLA YEAGER MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 06/21/2023
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9350 150 E SUITE 460
SANDY UT
84070
US

IV. Provider business mailing address

1069 E 300 S
SALT LAKE CITY UT
84102-2523
US

V. Phone/Fax

Practice location:
  • Phone: 506-596-1512
  • Fax:
Mailing address:
  • Phone: 406-596-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number12896621-4810
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: