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General NPI Number Information
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NPI Number | 1831817329
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Entity Type | Individual
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Provider Name | MARYAH TIPPING MAT, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 225 S UNIVERSITY AVE
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City | SAINT GEORGE
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State | UT
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Zip | 84770-3875
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Country | US
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Telephone | 435-652-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 731 W FIRE SKY DR
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City | SAINT GEORGE
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State | UT
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Zip | 84790-1945
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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 | 12939453-4810
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License Number State | UT
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