Provider Demographics
NPI:1457448144
Name:COLUMBIA REHABILITATION CLINIC
Entity Type:Organization
Organization Name:COLUMBIA REHABILITATION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-799-7007
Mailing Address - Street 1:1177 SUNSET BLVD
Mailing Address - Street 2:COLUMBIA REHABILITATION CLINIC
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-6863
Mailing Address - Country:US
Mailing Address - Phone:803-794-3440
Mailing Address - Fax:803-791-3862
Practice Address - Street 1:1177 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6863
Practice Address - Country:US
Practice Address - Phone:803-794-3440
Practice Address - Fax:803-791-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty