Active NPI
Brandon Hentkowski, ATC
- Athletic Trainer
- Salt Lake City, UT
National Provider Identifier
1588053151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000010234
- Practice address
- 590 S Wakara Way
Salt Lake City, UT 84108-1200 - Phone
- (801) 587-7198
- NPI assigned
- Jan 20, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000010234 | MI | Primary |
Addresses
Primary practice location
590 S Wakara Way
Salt Lake City, UT 84108-1200
Mailing address
590 S Wakara Way
Salt Lake City, UT 84108-1200
Phone (801) 587-7198
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000010234 | MI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421712000000",
"number": "1588053151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "590 S WAKARA WAY",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841081200",
"telephone_number": "801-587-7198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "590 S WAKARA WAY",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841081200",
"telephone_number": "801-587-7198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENTKOWSKI",
"first_name": "BRANDON",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-20",
"last_updated": "2015-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "2000010234",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.