Individual
ATLANTA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5926 S NORMANDY OAKS CIR, MURRAY, UT 84123-4918
(435) 419-0615
Mailing address
PO BOX 314, MONTICELLO, UT 84535-0314
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
01/20/2025
Last updated
06/18/2025
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