Provider Demographics
NPI:1285859819
Name:SOUTH AIKEN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SOUTH AIKEN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:803-649-9797
Mailing Address - Street 1:681 SILVER BLUFF RD STE A
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-4707
Mailing Address - Country:US
Mailing Address - Phone:803-649-9797
Mailing Address - Fax:803-642-2759
Practice Address - Street 1:681 SILVER BLUFF RD STE A
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-4707
Practice Address - Country:US
Practice Address - Phone:803-649-9797
Practice Address - Fax:803-642-2759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1405058OtherBCBS
DF9050OtherRAILROAD MEDICARE
SCGP4564Medicaid
DF9050OtherRAILROAD MEDICARE