| NPI | 1376658542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRSTEN JORDAN THOMPSON Owner/R PT 803-926-7204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 3014) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 3101) |
| 225100000X Physical Therapist (Licence: SC 3111) | |
| 225100000X Physical Therapist (Licence: SC 3021) | |
| 225X00000X Occupational Therapist (Licence: SC 2387) | |
| 225X00000X Occupational Therapist (Licence: SC 2898) | |
| 225X00000X Occupational Therapist (Licence: SC 2201) | |
| 225X00000X Occupational Therapist (Licence: SC 2682) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2019-03-11 |