Individual
DEBRA WILLARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1825 E SOUTH CAMPUS DR, ATHLETICS DEPT., SALT LAKE CITY, UT 84112-0900
(801) 581-4836
(801) 585-5005
Mailing address
1825 E SOUTH CAMPUS DR, ATHELTICS DEPT., SLC, UT 84112-0900
(801) 581-4836
(801) 585-5005
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
1216584810
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
ATHLETIC TRAINER
UT
Enumeration date
12/12/2006
Last updated
07/08/2007
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