Basic Information
| Provider Information | |||||||||
| NPI: | 1831461094 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TODD'S BODY SHOP, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 CORPORATE BLVD | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895027102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758256450 | ||||||||
| FaxNumber: | 7758256826 | ||||||||
| Practice Location | |||||||||
| Address1: | 1351 CORPORATE BLVD | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895027102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758256450 | ||||||||
| FaxNumber: | 7758256826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2012 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | EEKHOFF | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7758256450 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 500 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.