| NPI | 1245772755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON DANESE LOTT Billing/Credentialing Manager 803-667-1819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: SC 1580) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: SC 5266) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2019-07-25 |