Healthcare Provider Details

I. General information

NPI: 1649380288
Provider Name (Legal Business Name): TODD R SHROPSHIRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 JOHN J DELANEY DR SUITE 120
CHARLOTTE NC
28277-3146
US

IV. Provider business mailing address

4601 PARK RD SUITE 300
CHARLOTTE NC
28209-3239
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-3424
  • Fax: 704-323-3982
Mailing address:
  • Phone: 704-323-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP9859
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: