Provider Demographics
NPI:1033573688
Name:WHITING, TREVER (ATC/L)
Entity Type:Individual
Prefix:
First Name:TREVER
Middle Name:
Last Name:WHITING
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 N THUNDER BLVD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-3134
Mailing Address - Country:US
Mailing Address - Phone:801-610-8815
Mailing Address - Fax:801-768-1068
Practice Address - Street 1:99 N THUNDER BLVD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-3134
Practice Address - Country:US
Practice Address - Phone:801-610-8815
Practice Address - Fax:801-768-1068
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8396727-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer