Basic Information
| Provider Information | |||||||||
| NPI: | 1043438484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NALDER | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | CHARLES | ||||||||
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| OtherLastName: | NALDER | ||||||||
| OtherFirstName: | TODD | ||||||||
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| OtherCredential: | ATC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7120 PASADENA DR | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820092802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072861088 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5307 YELLOWSTONE RD | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820094736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076327677 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.