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General NPI Number Information
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NPI Number | 1265073761
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Entity Type | Individual
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Provider Name | TYSON B ROCKWELL
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Gender | Male
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Dates
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Enumeration Date | 10/05/2019
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Last Update Date | 10/05/2019
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Provider Practice Location Address
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Address Line | 455 S 500 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-2753
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Country | US
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Telephone | 801-328-6033
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Fax | 435-328-6027
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Provider Business Mailing Address
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Address Line | 370 CULROSS CIR
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City | STANSBURY PARK
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State | UT
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Zip | 84074-8166
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Country | US
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Telephone | 435-840-2767
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 7338418-1701
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License Number State | UT
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