Provider Demographics
NPI:1083943815
Name:PRS II, LLC
Entity Type:Organization
Organization Name:PRS II, LLC
Other - Org Name:PROFESSIONAL REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:KINMARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MTC, OCS
Authorized Official - Phone:843-831-0163
Mailing Address - Street 1:PO BOX 2397
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-2397
Mailing Address - Country:US
Mailing Address - Phone:843-235-0200
Mailing Address - Fax:843-235-0242
Practice Address - Street 1:3076 DICK POND ROAD UNIT 4
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575
Practice Address - Country:US
Practice Address - Phone:843-831-0163
Practice Address - Fax:843-831-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5324Medicaid
SCDQ9787OtherRAILROAD MEDICARE PTAN
SC9403Medicare PIN