Provider Demographics
NPI:1134119670
Name:TORODE, CARL M (PT)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:M
Last Name:TORODE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:CHUCK
Other - Middle Name:M
Other - Last Name:TORODE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-0720
Mailing Address - Country:US
Mailing Address - Phone:434-946-1314
Mailing Address - Fax:434-946-1083
Practice Address - Street 1:210 S MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-2616
Practice Address - Country:US
Practice Address - Phone:434-946-1314
Practice Address - Fax:434-946-1083
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA318235OtherBLUE CROSS BLUE SHIELD
VA210448OtherSOUTHERN HEALTH
VAC06781Medicare UPIN