Provider Demographics
NPI:1629596218
Name:GIROUARD, TEDD (ATC)
Entity Type:Individual
Prefix:MR
First Name:TEDD
Middle Name:
Last Name:GIROUARD
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 1:4505 S MARYLAND PKWY # 3034
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89154-9900
Mailing Address - Country:US
Mailing Address - Phone:702-895-5828
Mailing Address - Fax:702-895-5828
Practice Address - Street 1:4505 S MARYLAND PKWY # 3034
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89154-9900
Practice Address - Country:US
Practice Address - Phone:702-895-5828
Practice Address - Fax:702-895-5828
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05060272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer