Provider Demographics
NPI:1184748691
Name:JAMESON, TREVOR (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:
Last Name:JAMESON
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 1:5452 HEWS PL
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-1416
Mailing Address - Country:US
Mailing Address - Phone:801-840-5152
Mailing Address - Fax:
Practice Address - Street 1:1825 E SOUTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84112-0900
Practice Address - Country:US
Practice Address - Phone:801-585-3861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6312558-4810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist