Healthcare Provider Details

I. General information

NPI: 1093473571
Provider Name (Legal Business Name): TORIAN EDWARDS RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 6TH BAXTER XING # B
FORT MILL SC
29708-6596
US

IV. Provider business mailing address

502 6TH BAXTER XING # B
FORT MILL SC
29708-6596
US

V. Phone/Fax

Practice location:
  • Phone: 704-788-2016
  • Fax:
Mailing address:
  • Phone: 704-788-2016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: