Provider Demographics
NPI:1407647167
Name:BASS, JOHN TODD (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TODD
Last Name:BASS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1222
Mailing Address - Country:US
Mailing Address - Phone:303-444-1290
Mailing Address - Fax:303-444-1837
Practice Address - Street 1:2706 28TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1222
Practice Address - Country:US
Practice Address - Phone:303-444-1290
Practice Address - Fax:303-444-1837
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist