MEDICARE: JOHN TODD BASS DPT

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	225100000X	Physical Therapist	20547	CO

General Provider Information

NPI Number	:	1407647167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN TODD BASS DPT

Provider Business Mailing Address
First Line	:	2706 28TH ST
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-1222
Country	:	US
Telephone Number	:	303-444-1290
Fax Number	:	303-444-1837

Provider Business Practice Location Address
First Line	:	2706 28TH ST
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-1222
Country	:	US
Telephone Number	:	303-444-1290
Fax Number	:	303-444-1837

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

Provider Enumeration Date	:	05/13/2025
Last Update Date	:	05/13/2025

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