Provider Demographics
NPI:1851368203
Name:ANDERSON, MICHAEL B (MS, ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3898 DAVENCOURT LOOP
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4588
Mailing Address - Country:US
Mailing Address - Phone:801-372-9288
Mailing Address - Fax:
Practice Address - Street 1:1820 SIDEWINDER DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7492
Practice Address - Country:US
Practice Address - Phone:435-655-6600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer