Basic Information
Provider Information | |||||||||
NPI: | 1134119670 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TORODE | ||||||||
FirstName: | CARL | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | P.T. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TORODE | ||||||||
OtherFirstName: | CHUCK | ||||||||
OtherMiddleName: | M. | ||||||||
OtherNamePrefix: | MR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | P.T. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 720 | ||||||||
Address2: |   | ||||||||
City: | AMHERST | ||||||||
State: | VA | ||||||||
PostalCode: | 245210720 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4349461314 | ||||||||
FaxNumber: | 4349461083 | ||||||||
Practice Location | |||||||||
Address1: | 210 S MAIN ST | ||||||||
Address2: |   | ||||||||
City: | AMHERST | ||||||||
State: | VA | ||||||||
PostalCode: | 245212616 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4349461314 | ||||||||
FaxNumber: | 4349461083 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/26/2005 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305001479 | VA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 318235 | 01 | VA | BLUE CROSS BLUE SHIELD | OTHER | 210448 | 01 | VA | SOUTHERN HEALTH | OTHER |