MEDICARE: MR. RICK HACKFORD ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer
2	225700000X	Massage Therapist	3105605-4701	UT

General Provider Information

NPI Number	:	1245290691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICK HACKFORD ATC

Provider Business Mailing Address
First Line	:	6270 W 3705 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84128-2560
Country	:	US
Telephone Number	:	801-832-2341
Fax Number	:

Provider Business Practice Location Address
First Line	:	6270 W 3705 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84128-2560
Country	:	US
Telephone Number	:	801-832-2341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	09/11/2025

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