Provider Demographics
NPI:1225889181
Name:SWAMP RABBIT PHYSIOTHERAPY AND PERFORMANCE LLC
Entity Type:Organization
Organization Name:SWAMP RABBIT PHYSIOTHERAPY AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-467-9006
Mailing Address - Street 1:19 ROCKY MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3663
Mailing Address - Country:US
Mailing Address - Phone:480-467-9006
Mailing Address - Fax:
Practice Address - Street 1:19 ROCKY MEADOW CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3663
Practice Address - Country:US
Practice Address - Phone:480-467-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty