| NPI | 1598358954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY CANNON Owner 843-379-3991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2024-07-09 |