Provider Demographics
NPI:1366647422
Name:PALMETTO PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PALMETTO PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:864-879-7757
Mailing Address - Street 1:420 THE PARKWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650
Mailing Address - Country:US
Mailing Address - Phone:864-879-7757
Mailing Address - Fax:864-879-4626
Practice Address - Street 1:420 THE PARKWAY
Practice Address - Street 2:SUITE D
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650
Practice Address - Country:US
Practice Address - Phone:864-879-7757
Practice Address - Fax:864-879-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7494Medicare PIN