Provider Demographics
NPI:1467405860
Name:UPPER EXTREMITY REHAB SPECIALISTS, PA
Entity Type:Organization
Organization Name:UPPER EXTREMITY REHAB SPECIALISTS, PA
Other - Org Name:PHYSICAL THERAPY &UPPER EXTREMITY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED HAND THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/CHT
Authorized Official - Phone:864-286-9966
Mailing Address - Street 1:201 ROPER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6927
Mailing Address - Country:US
Mailing Address - Phone:864-286-9966
Mailing Address - Fax:864-286-9933
Practice Address - Street 1:201 ROPER CREEK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6927
Practice Address - Country:US
Practice Address - Phone:864-286-9966
Practice Address - Fax:864-286-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC736225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7649611OtherAETNA IDENTIFIER
SCQ333637881Medicare UPIN
SC7649611OtherAETNA IDENTIFIER
SC7881Medicare PIN