Travis C Jackson, ATC-L Valid NPI

Individual provider · Athletic Trainer · Smithfield, UT

NPI

1528345212

Type

Individual (Type 1)

Primary specialty

Athletic Trainer (Specialist/Technologist)

Specialty group

Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Taxonomy code

2255A2300X

License number

6852418-4810 (UT)

Sex

Male

Sole proprietor

Yes

Enumerated

2011-11-08

Last updated

2011-11-08