Individual
COURTNEY DIANE KENEFICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
201 PRESIDENTS CIR, SALT LAKE CITY, UT 84112-9049
(801) 585-3861
Mailing address
9 VISTA DR, SHREWSBURY, MA 01545-2025
(774) 249-9293
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
10770591-4810
UT
Other
Enumeration date
09/30/2018
Last updated
09/30/2018
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