Provider Demographics
NPI:1265826994
Name:ESPINOZA, THEODORE LLOYD (ATC)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:LLOYD
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 ANN ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2437
Mailing Address - Country:US
Mailing Address - Phone:307-286-6490
Mailing Address - Fax:
Practice Address - Street 1:255 ANN ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2437
Practice Address - Country:US
Practice Address - Phone:307-286-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer