Provider Demographics
NPI:1710254701
Name:FAISON, TODD PATRICK (MED, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:PATRICK
Last Name:FAISON
Suffix:
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 31ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3517
Mailing Address - Country:US
Mailing Address - Phone:806-543-3917
Mailing Address - Fax:
Practice Address - Street 1:1504 E. ITASCA AVE.
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79403
Practice Address - Country:US
Practice Address - Phone:806-766-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT24272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer