Provider Demographics
NPI:1124092390
Name:JAGER, TODD JACOB I (ATC)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:JACOB
Last Name:JAGER
Suffix:I
Gender:M
Credentials:ATC
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Mailing Address - Street 1:1 CAMPUS DR
Mailing Address - Street 2:GRAND VALLEY STATE UNIVERSITY, 84 FIELD HOUSE
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9401
Mailing Address - Country:US
Mailing Address - Phone:616-331-3329
Mailing Address - Fax:616-331-3232
Practice Address - Street 1:1 CAMPUS DR
Practice Address - Street 2:GRAND VALLEY STATE UNIVERSITY, 84 FIELD HOUSE
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9401
Practice Address - Country:US
Practice Address - Phone:616-331-3329
Practice Address - Fax:616-331-3232
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer