Individual
FORREST SUTHERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1075 E 41ST ST., OGDEN, UT 84403
(435) 962-0738
Mailing address
1075 41ST ST, OGDEN, UT 84403-2405
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS
—
Enumeration date
09/05/2017
Last updated
09/05/2017
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