Individual
MR. CLINTON GEORGE EDVALSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 314-4051
Mailing address
1034 N 500 W, PROVO, UT 84604-3380
(801) 314-4051
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0506194
NV
2255A2300X
Athletic Trainer
Primary
6364162-4810
UT
Other
Enumeration date
02/16/2007
Last updated
06/23/2022
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