Healthcare Provider Details

I. General information

NPI: 1871826859
Provider Name (Legal Business Name): MAXWELL J TODOROFF PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 EAST ST
PITTSBORO NC
27312-8860
US

IV. Provider business mailing address

103 N MAIN ST STE 300
GREENVILLE SC
29601-2796
US

V. Phone/Fax

Practice location:
  • Phone: 864-942-0240
  • Fax:
Mailing address:
  • Phone: 864-528-5700
  • Fax: 864-528-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12160
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6115
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: