Provider Demographics
NPI:1114995503
Name:LAND, TAO LEE (ATC,LAT)
Entity Type:Individual
Prefix:MR
First Name:TAO
Middle Name:LEE
Last Name:LAND
Suffix:
Gender:M
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MOBY ARENA
Mailing Address - Street 2:CSU ATHLETICS
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80523-0120
Mailing Address - Country:US
Mailing Address - Phone:970-889-1702
Mailing Address - Fax:970-491-6167
Practice Address - Street 1:141 MOBY ARENA
Practice Address - Street 2:CSU ATHLETICS
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-0120
Practice Address - Country:US
Practice Address - Phone:970-889-1702
Practice Address - Fax:970-491-6167
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960015022255A2300X
COAT.00013172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer