Provider Demographics
NPI:1417537697
Name:OFF THE BLOCK PHYSICAL THERAPY
Entity Type:Organization
Organization Name:OFF THE BLOCK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:864-561-5493
Mailing Address - Street 1:125 ARBORS CT
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:SC
Mailing Address - Zip Code:29630-3700
Mailing Address - Country:US
Mailing Address - Phone:864-561-5493
Mailing Address - Fax:
Practice Address - Street 1:125 ARBORS CT
Practice Address - Street 2:
Practice Address - City:CENTRAL
Practice Address - State:SC
Practice Address - Zip Code:29630-3700
Practice Address - Country:US
Practice Address - Phone:864-561-5493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy