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General NPI Number Information
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NPI Number | 1366104978
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Entity Type | Individual
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Provider Name | MADYSON MARIE MEEKS
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Gender | Female
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 150 SKYHAWK BLVD
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City | WOODLAND HILLS
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State | UT
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Zip | 84653-5559
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Country | US
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Telephone | 801-423-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 1371 S 2900 E
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City | SPANISH FORK
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State | UT
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Zip | 84660-3105
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Country | US
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Telephone | 801-859-9658
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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 | 123943584810
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License Number State | UT
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