Healthcare Provider Details

I. General information

NPI: 1003143249
Provider Name (Legal Business Name): SAMANTHA LYNNE WINDER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N 250 W
SMITHFIELD UT
84335-1812
US

IV. Provider business mailing address

330 N 250 W
SMITHFIELD UT
84335-1812
US

V. Phone/Fax

Practice location:
  • Phone: 435-650-4301
  • Fax:
Mailing address:
  • Phone: 435-650-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number8380211-4810
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: