Provider Demographics
NPI:1285865279
Name:ISLAND PHYSICAL THERAPY & SPORTS REHAB
Entity Type:Organization
Organization Name:ISLAND PHYSICAL THERAPY & SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILMOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-482-0064
Mailing Address - Street 1:15 E LAFAYETTE PLACE
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2276
Mailing Address - Country:US
Mailing Address - Phone:843-342-3012
Mailing Address - Fax:843-342-9768
Practice Address - Street 1:15 LAFAYETTE PL
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2276
Practice Address - Country:US
Practice Address - Phone:843-342-3012
Practice Address - Fax:843-342-9768
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEMSON SPORTS MEDICINE & REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies