MEDICARE: MR. TODD HOWARD GOSHORN ATC

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	90	NE

General Provider Information

NPI Number	:	1851593834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD HOWARD GOSHORN ATC

Provider Business Mailing Address
First Line	:	3107 W 18TH ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-2404
Country	:	US
Telephone Number	:	308-381-2702
Fax Number	:

Provider Business Practice Location Address
First Line	:	3107 W 18TH ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-2404
Country	:	US
Telephone Number	:	308-381-2702
Fax Number	:

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

Provider Enumeration Date	:	06/03/2007
Last Update Date	:	07/08/2007

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