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General NPI Number Information
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NPI Number | 1346165537
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Entity Type | Individual
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Provider Name | BLAIRE BUCKLEY MS, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 777 N 5600 W
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City | SALT LAKE CITY
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State | UT
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Zip | 84116-3981
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Country | US
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Telephone | 480-371-0019
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Fax |
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Provider Business Mailing Address
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Address Line | 212 E HAMPTON AVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-4611
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Country | US
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Telephone | 480-371-0019
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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 | 14197615-4810
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License Number State | UT
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