| NPI | 1053837112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS RICHARD ITTENBACH Sole Mbr 843-715-4146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 4852) |
| Enumeration Date | 2017-08-20 |
| Last Update Date | 2018-01-31 |