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NPI Code Detail

MEDICARE: MR. CHRISTOPHER TODD ROY M.ED.,ATC, LAT, CSCS

MEDICARE: MR. CHRISTOPHER TODD ROY M.ED.,ATC, LAT, CSCS
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
12255A2300XAthletic Trainer24-00388KS
22255A2300XAthletic Trainer060002519KS

General Provider Information

NPI Number : 1962551051
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHRISTOPHER TODD ROY M.ED.,ATC, LAT, CSCS
Provider Business Mailing Address
First Line : 1017 N VERDA ST
Second Line :
City : WICHITA
State : KS
Zip : 67203-4373
Country : US
Telephone Number : 316-943-3757
Fax Number :
Provider Business Practice Location Address
First Line : 12112 W KELLOGG ST
Second Line :
City : WICHITA
State : KS
Zip : 67235-1100
Country : US
Telephone Number : 316-440-1100
Fax Number : 316-440-1089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 05/14/2014

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