Provider Demographics
NPI:1508313289
Name:QUAMMEN, DAVID (MSED, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:QUAMMEN
Suffix:
Gender:M
Credentials:MSED, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980356
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-0356
Mailing Address - Country:US
Mailing Address - Phone:435-602-2672
Mailing Address - Fax:
Practice Address - Street 1:1 VICTORY LN # 100
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7463
Practice Address - Country:US
Practice Address - Phone:435-602-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8767305-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer