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General NPI Number Information
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NPI Number | 1477161735
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Entity Type | Individual
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Provider Name | CAROLINE MCCLEERY VIXAYSACK PT, DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 6272 S HIGHLAND DR STE 203
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City | MURRAY
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State | UT
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Zip | 84121-2126
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Country | US
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Telephone | 801-871-6350
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 25537
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City | SALT LAKE CITY
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State | UT
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Zip | 84125-0537
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Country | US
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Telephone |
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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 | 11881200-4810
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11881200-2401
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License Number State | UT
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