Provider Demographics
NPI:1184673071
Name:INDIVIDUALIZED PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:INDIVIDUALIZED PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, RPT
Authorized Official - Phone:864-232-6982
Mailing Address - Street 1:25 WOODS LAKE RD
Mailing Address - Street 2:SUITE 709
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6125
Mailing Address - Country:US
Mailing Address - Phone:864-232-6982
Mailing Address - Fax:864-232-6983
Practice Address - Street 1:25 WOODS LAKE RD
Practice Address - Street 2:SUITE 709
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6125
Practice Address - Country:US
Practice Address - Phone:864-232-6982
Practice Address - Fax:864-232-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty