NPI 1033619325

Deyonta Tolliver, LATATC

Practitioner Athletic Trainer Saint Louis, MO

Practice location

Address: 11628 Old Ballas Rd, Saint Louis, MO 63141-7030
Phone: (314) 596-2656
Mailing address: 2519 Hardwood Dr, Bryan, TX 77803-0258

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence 2017031424 (MO)

Other Specialist/Technologist providers in Missouri →

Registry record

NPI: 1033619325
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Feb 2018
Record last updated: 14 Feb 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.