Provider Demographics
NPI:1851622864
Name:WAYNE, SEAN CHRISTOPHER (ATC,LMT)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:CHRISTOPHER
Last Name:WAYNE
Suffix:
Gender:M
Credentials:ATC,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 E 1510 N
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-7706
Mailing Address - Country:US
Mailing Address - Phone:801-628-3657
Mailing Address - Fax:
Practice Address - Street 1:181 WEST 600 SOUTH
Practice Address - Street 2:BLDG 3A
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404
Practice Address - Country:US
Practice Address - Phone:801-628-3657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6355752-48102255A2300X
UT6355752-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist