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NPI Code Detail

MEDICARE: MICHAEL ELLIOTT ATC

MEDICARE: MICHAEL ELLIOTT 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
12255A2300XAthletic Trainer070202240AZ

General Provider Information

NPI Number : 1740859875
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ELLIOTT ATC
Provider Business Mailing Address
First Line : 1531 E KENSINGTON AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84105-2803
Country : US
Telephone Number : 602-999-7738
Fax Number :
Provider Business Practice Location Address
First Line : 1420 S 500 W
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-5149
Country : US
Telephone Number : 602-999-7738
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2021
Last Update Date : 06/22/2021

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Directions to “ MICHAEL ELLIOTT ATC” Practice Location

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