Healthcare Provider Details

I. General information

NPI: 1134770217
Provider Name (Legal Business Name): TODD A EVANS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF NORTHERN IOWA HUMAN PERFORMANCE CTR 3B
CEDAR FALLS IA
50614-0001
US

IV. Provider business mailing address

UNIVERSITY OF NORTHERN IOWA HUMAN PERFORMANCE CTR 3B
CEDAR FALLS IA
50614-0244
US

V. Phone/Fax

Practice location:
  • Phone: 319-230-4458
  • Fax:
Mailing address:
  • Phone: 319-273-6152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number00447
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: