Individual
GRAYDON WICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC-L, LMT, CSS
Contact information
Practice address
3336 S PIONEER PKWY, SUITE 101, WEST VALLEY CITY, UT 84120-2000
(801) 964-3100
Mailing address
3336 S PIONEER PKWY, SUITE 101, WEST VALLEY CITY, UT 84120-2000
(801) 964-3100
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
514032-4810
UT
Other
Enumeration date
09/18/2014
Last updated
09/18/2014
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