Healthcare Provider Details

I. General information

NPI: 1679048664
Provider Name (Legal Business Name): SHAUN MICHAEL NORTON MS, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 DESERT HILLS DR
ST GEORGE UT
84790-4934
US

IV. Provider business mailing address

828 DESERT HILLS DR
ST GEORGE UT
84790-4934
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-0885
  • Fax:
Mailing address:
  • Phone: 435-674-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number81277524810
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number8127752-4810
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: