Individual
MRS. LESLIE T. BASTIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AT,C.
Contact information
Practice address
366 E 1100 S, MAPLETON, UT 84664-5012
(801) 491-2199
Mailing address
366 E 1100 S, MAPLETON, UT 84664-5012
(801) 491-2199
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
PROVIDER CODE
UT
Enumeration date
12/19/2011
Last updated
12/19/2011
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