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NPI Code Detail

MEDICARE: DR. BARNETT SAMUEL FRANK LAT, ATC

MEDICARE: DR. BARNETT SAMUEL FRANK LAT, 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 Trainer10863470-4810UT

General Provider Information

NPI Number : 1881218048
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BARNETT SAMUEL FRANK LAT, ATC
Provider Business Mailing Address
First Line : 3641 WAGON WHEEL WAY
Second Line :
City : PARK CITY
State : UT
Zip : 84098-5340
Country : US
Telephone Number :
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 : 203-512-4235
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2020
Last Update Date : 06/03/2020

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