Healthcare Provider Details

I. General information

NPI: 1205012168
Provider Name (Legal Business Name): TODD KLEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 EDWARDS AVE
CEDAR FALLS IA
50613-4711
US

IV. Provider business mailing address

1903 EDWARDS AVE
CEDAR FALLS IA
50613-4711
US

V. Phone/Fax

Practice location:
  • Phone: 319-277-1925
  • Fax: 319-232-6140
Mailing address:
  • Phone: 319-277-1925
  • Fax: 319-232-6140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number00215
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: