Provider Demographics
NPI:1578555868
Name:JOHN, TODD ALLEN (ATC/L)
Entity Type:Individual
Prefix:PROF
First Name:TODD
Middle Name:ALLEN
Last Name:JOHN
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:MR
Other - First Name:SUDSY
Other - Middle Name:ALLEN
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1600 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2578
Mailing Address - Country:US
Mailing Address - Phone:417-328-1988
Mailing Address - Fax:417-328-1487
Practice Address - Street 1:1600 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2578
Practice Address - Country:US
Practice Address - Phone:417-328-1988
Practice Address - Fax:417-328-1487
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010203032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer