Deyonta Tolliver, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2017031424 Issued in MO

Practice address

11628 Old Ballas Rd
Saint Louis, MO 63141-7030

Phone

(314) 596-2656

NPI assigned

Feb 14, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518566400000",
    "number": "1033619325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2519 HARDWOOD DR",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778030258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11628 OLD BALLAS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417030",
            "telephone_number": "314-596-2656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLLIVER",
        "first_name": "DEYONTA",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-14",
        "last_updated": "2018-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2017031424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Elizabeth Toler, FNP-C
• Mary Katherine Toler, CRNA
• Tomi Lynn Toler, CGC
• Douglas M Tollefsen, MD
• Sherida E Tollefsen, MD
• Keisha Tolliver
• Danielle Sultana Tolmais, NONE
• Tony J Toloczko, MD
• Tom Sotiropoulos Metro Dental Sleep Medicine
• Octavian Toma, MD

• Athletic Trainer in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.