Individual
KYLE WEINBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
590 S WAKARA WAY, SALT LAKE CITY, UT 84108-1200
(123) 456-7890
Mailing address
590 S WAKARA WAY, SALT LAKE CITY, UT 84108-1200
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
10870239-4810
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10870239-4810
UTAH DOPL
UT
01
—
2000032833
BOARD OF CERTIFICATION
—
Enumeration date
04/18/2019
Last updated
04/15/2024
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