MEDICARE: TODD TOMCZYK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	RT002093A	PA

General Provider Information

NPI Number	:	1306508338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD TOMCZYK

Provider Business Mailing Address
First Line	:	115 FEDERAL ST STE 115B
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-5740
Country	:	US
Telephone Number	:	216-533-8404
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 CHAPEL HARBOR DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-3154
Country	:	US
Telephone Number	:	216-533-8404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2021
Last Update Date	:	10/07/2021

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Directions to “ TODD TOMCZYK ” Practice Location

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