Provider Demographics
NPI:1700239548
Name:BRESLEY, AMY (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BRESLEY
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E 2200 N
Mailing Address - Street 2:APT D307
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-4710
Mailing Address - Country:US
Mailing Address - Phone:425-829-6860
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:84322-7425
Practice Address - Country:US
Practice Address - Phone:425-829-6860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-17
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9473934-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer