Individual
MR. TIMOTHY JAMES BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT, CES
Contact information
Practice address
1143 SFH, PROVO, UT 84602-2246
(801) 422-0974
Mailing address
1143 SFH, PROVO, UT 84602-2246
(805) 760-8213
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
1560
TN
2255A2300X
Athletic Trainer
Primary
6123836-4810
UT
Other
Enumeration date
11/16/2017
Last updated
06/03/2022
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