Healthcare Provider Details

I. General information

NPI: 1447662168
Provider Name (Legal Business Name): TODD BRYNDS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N. PINE
PITTSBURG KS
66762
US

IV. Provider business mailing address

100 N. PINE, P.O. BOX 358
PITTSBURG KS
66762
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-3750
  • Fax: 620-232-1715
Mailing address:
  • Phone: 620-231-3750
  • Fax: 620-232-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-00125
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: