Provider Demographics
NPI:1053484824
Name:MAGNOLIA PHYSICAL THERAPY,PA
Entity Type:Organization
Organization Name:MAGNOLIA PHYSICAL THERAPY,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:864-226-3333
Mailing Address - Street 1:108 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3334
Mailing Address - Country:US
Mailing Address - Phone:864-226-3333
Mailing Address - Fax:864-225-6551
Practice Address - Street 1:108 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3334
Practice Address - Country:US
Practice Address - Phone:864-226-3333
Practice Address - Fax:864-225-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1309261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherPHYSICAL THERAPY