Individual
MCKENNA BOOTHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
12943 S 700 E, DRAPER, UT 84020-6200
(801) 826-6400
Mailing address
1032 E OLD DAIRY RD, SANDY, UT 84094-7210
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
10416520-4810
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10416520-4810
STATE LICENSE NUMBER
UT
Enumeration date
04/16/2019
Last updated
06/11/2019
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