Individual provider Active NPI

Sean Christopher Wayne, ATC,LMT

  • Athletic Trainer
  • Ogden, UT
National Provider Identifier
1851622864
Registry record updated Jan 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
6355752-4810 Issued in UT
Practice address
181 West 600 South
BLDG 3a
Ogden, UT 84404
Phone
(801) 628-3657
NPI assigned
Jan 15, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 6355752-4810 UT Primary
Massage Therapist 225700000X 6355752-4701 UT

Addresses

Primary practice location

181 West 600 South
BLDG 3a
Ogden, UT 84404

Mailing address

939 E 1510 N
North Ogden, UT 84404-7706
Phone (801) 628-3657

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

LicenseStateTypeSpecialty
6355752-4810UTMDAthletic Trainer
6355752-4701UTMDMassage Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263513600000",
    "number": "1851622864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "939 E 1510 N",
            "city": "NORTH OGDEN",
            "state": "UT",
            "postal_code": "844047706",
            "telephone_number": "801-628-3657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 WEST 600 SOUTH",
            "address_2": "BLDG 3A",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "84404",
            "telephone_number": "801-628-3657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAYNE",
        "first_name": "SEAN",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Mr.",
        "credential": "ATC,LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-15",
        "last_updated": "2010-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "UT",
            "license": "6355752-4810",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "UT",
            "license": "6355752-4701",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.