Individual provider · NPI-1

Jeannette Utterback, ATC, LAT

Specialist/Technologist, Athletic Trainer · Addison, TX

NPI number1184128951
StatusActive
Last updated in NPPESMar 19, 2018

Details

NPI
1184128951
Entity type
Individual (NPI-1)
Name
Jeannette Utterback
Credential
ATC, LAT
Sex
Female
Sole proprietor
No
Enumeration date
Mar 19, 2018
Last updated
Mar 19, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic TrainerAT6563TXYes

Practice location

17001 Addison Rd
Addison, TX 75001-5096

Phone 972-931-8325

Mailing address

2501 Scarlet Oak Dr
Rowlett, TX 75089-1651

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