Healthcare Provider Details

I. General information

NPI: 1619177334
Provider Name (Legal Business Name): ROBERT TARDELL CFO, CFTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 JAKE ALEXANDER BLVD W SUITE 102
SALISBURY NC
28147-1317
US

IV. Provider business mailing address

350 JAKE ALEXANDER BLVD W SUITE 102
SALISBURY NC
28147-1317
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-4000
  • Fax: 704-633-4200
Mailing address:
  • Phone: 704-633-4000
  • Fax: 704-633-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFO02450
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFTS1014
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: