Provider Demographics
NPI:1952651598
Name:TOOLEY, TODD
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:TOOLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 W ROCHELLE AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3455
Mailing Address - Country:US
Mailing Address - Phone:702-376-3503
Mailing Address - Fax:
Practice Address - Street 1:5835 W ROCHELLE AVE APT 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3455
Practice Address - Country:US
Practice Address - Phone:702-376-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner