Provider Demographics
NPI:1992493050
Name:TODD, MICHAEL C (PTA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:TODD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12424 LAKE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6712
Mailing Address - Country:US
Mailing Address - Phone:352-457-7580
Mailing Address - Fax:
Practice Address - Street 1:627 8TH ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2159
Practice Address - Country:US
Practice Address - Phone:352-243-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA32709225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant