Provider Demographics
NPI:1104151638
Name:CONGER, TODD JOSEPH (ATC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:JOSEPH
Last Name:CONGER
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 1:17913 ORANGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-7062
Mailing Address - Country:US
Mailing Address - Phone:951-833-6306
Mailing Address - Fax:
Practice Address - Street 1:43500 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9305
Practice Address - Country:US
Practice Address - Phone:760-773-2586
Practice Address - Fax:760-568-7503
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer