Provider Demographics
NPI:1275690596
Name:PHYSICAL THERAPY CENTER LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORION
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-681-5900
Mailing Address - Street 1:20 PALMETTO PKWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2433
Mailing Address - Country:US
Mailing Address - Phone:843-681-5900
Mailing Address - Fax:843-681-5901
Practice Address - Street 1:20 PALMETTO PKWY
Practice Address - Street 2:SUITE F
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2433
Practice Address - Country:US
Practice Address - Phone:843-681-5900
Practice Address - Fax:843-681-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5031261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8686Medicare PIN