MEDICARE: SHAUN MICHAEL NORTON MS, ATC, LAT

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	81277524810	UT
2	2255A2300X	Athletic Trainer	8127752-4810	UT

General Provider Information

NPI Number	:	1679048664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN MICHAEL NORTON MS, ATC, LAT

Provider Business Mailing Address
First Line	:	828 DESERT HILLS DR
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-4934
Country	:	US
Telephone Number	:	435-674-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 DESERT HILLS DR
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-4934
Country	:	US
Telephone Number	:	435-674-0885
Fax Number	:

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

Provider Enumeration Date	:	10/05/2018
Last Update Date	:	10/05/2018

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