Healthcare Provider Details

I. General information

NPI: 1407078595
Provider Name (Legal Business Name): TIMOTHY D TORBORG ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EXECUTIVE DR SUITE B
DANVILLE VA
24541-4155
US

IV. Provider business mailing address

74 SYCAMORE CIR
DANVILLE VA
24540-5352
US

V. Phone/Fax

Practice location:
  • Phone: 434-793-4711
  • Fax: 434-792-2818
Mailing address:
  • Phone: 434-835-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000259
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: