Provider Demographics
NPI:1407888605
Name:CHERAW PHYSICAL THERAPY & REHABILITATION CENTER LLC.
Entity Type:Organization
Organization Name:CHERAW PHYSICAL THERAPY & REHABILITATION CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:SALAMANCA
Authorized Official - Last Name:STO.DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-320-8000
Mailing Address - Street 1:309 CHESTERFIELD HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-3052
Mailing Address - Country:US
Mailing Address - Phone:843-320-8000
Mailing Address - Fax:843-320-8002
Practice Address - Street 1:309 CHESTERFIELD HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-3052
Practice Address - Country:US
Practice Address - Phone:843-320-8000
Practice Address - Fax:843-320-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2899225100000X
SC5225225100000X
SC1698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3247Medicaid
SCGP3247Medicaid