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General NPI Number Information
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NPI Number | 1649741497
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Entity Type | Individual
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Provider Name | SAVANNAH MARIE SELLARS LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 5225 S REDWOOD RD
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-4213
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Country | US
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Telephone | 801-380-1689
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Fax |
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Provider Business Mailing Address
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Address Line | 151 E 1060 N
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City | OREM
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State | UT
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Zip | 84057-3263
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Country | US
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Telephone | 801-380-1689
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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 | 101434094810
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License Number State | UT
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