Provider Demographics
NPI:1164971925
Name:UTAH STATE UNIVERSIRY
Entity Type:Organization
Organization Name:UTAH STATE UNIVERSIRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE AD FOR ATHLETIC TRAINING
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATC
Authorized Official - Phone:435-797-3444
Mailing Address - Street 1:7425 OLD MAIN HILL
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-2400
Mailing Address - Country:US
Mailing Address - Phone:435-797-3444
Mailing Address - Fax:
Practice Address - Street 1:7425 OLD MAIN HL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-2400
Practice Address - Country:US
Practice Address - Phone:435-797-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty