Provider Demographics
NPI:1649380288
Name:SHROPSHIRE, TODD R
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:R
Last Name:SHROPSHIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3239
Mailing Address - Country:US
Mailing Address - Phone:704-323-2000
Mailing Address - Fax:
Practice Address - Street 1:15825 JOHN J DELANEY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3146
Practice Address - Country:US
Practice Address - Phone:704-323-3424
Practice Address - Fax:704-323-3982
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP9859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9859OtherLICENSE #
NC9859OtherLICENSE #
NC2312769Medicare PIN