Provider Demographics
NPI:1134770217
Name:EVANS, TODD A (ATC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:EVANS
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:UNIVERSITY OF NORTHERN IOWA HUMAN PERFORMANCE CTR 3B
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50614-0244
Mailing Address - Country:US
Mailing Address - Phone:319-273-6152
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NORTHERN IOWA HUMAN PERFORMANCE CTR 3B
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50614-0001
Practice Address - Country:US
Practice Address - Phone:319-230-4458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer