Provider Demographics
NPI:1326084849
Name:THREE RIVERS THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:THREE RIVERS THERAPY ASSOCIATES, INC.
Other - Org Name:THREE RIVERS THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-558-4830
Mailing Address - Street 1:401 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HEMINGWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29554-9191
Mailing Address - Country:US
Mailing Address - Phone:843-558-4830
Mailing Address - Fax:843-558-7752
Practice Address - Street 1:401 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:HEMINGWAY
Practice Address - State:SC
Practice Address - Zip Code:29554-9191
Practice Address - Country:US
Practice Address - Phone:843-558-4830
Practice Address - Fax:843-558-7752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC426611Medicare PIN