Individual
LARRY C WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.T.,C.
Contact information
Practice address
1738 W 12600 S, RIVERTON, UT 84065-7025
(801) 243-7346
(801) 446-0909
Mailing address
1738 W 12600 S, RIVERTON, UT 84065-7025
(801) 243-7346
(801) 446-0909
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
ATHLETIC TRAINER
UT
Enumeration date
07/20/2006
Last updated
07/08/2007
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