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General NPI Number Information
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NPI Number | 1992163166
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Entity Type | Individual
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Provider Name | MARK ERIC BEESE ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 02/03/2016
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Provider Practice Location Address
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Address Line | 590 S WAKARA WAY
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-1200
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Country | US
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Telephone | 801-587-1473
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Fax | 801-587-7115
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Provider Business Mailing Address
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Address Line | 580 WAKARA WAY
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City | SALT LAKE CITY
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State | UT
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Zip | 84108
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Country | US
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Telephone | 801-587-1473
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Fax | 801-587-7115
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 7726414-4810
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License Number State | UT
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