Leslie T. Bastian, AT,C.
Individual provider Active NPI Athletic Trainer · Mapleton, UT
NPI 1013286152 · NPPES record last updated Dec 19, 2011
Key facts
- NPI
- 1013286152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 366 E 1100 S
Mapleton, UT 84664-5012 - Phone
- (801) 491-2199
- NPI assigned
- Dec 19, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | UT | Yes |
Addresses
Primary practice location
366 E 1100 S
Mapleton, UT 84664-5012
Mailing address
366 E 1100 S
Mapleton, UT 84664-5012
Phone (801) 491-2199
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22 | Other | UT | PROVIDER CODE |
Other providers in Mapleton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.