Provider Demographics
NPI:1346507571
Name:ENVISION THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:ENVISION THERAPY SERVICES, LLC
Other - Org Name:PETITE REHAB PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:MCGRAW
Authorized Official - Last Name:WICKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:803-360-8797
Mailing Address - Street 1:118A N BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6902
Mailing Address - Country:US
Mailing Address - Phone:803-897-7022
Mailing Address - Fax:803-832-1572
Practice Address - Street 1:211 CHAPELWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7121
Practice Address - Country:US
Practice Address - Phone:803-661-9533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
SC4836261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty