Provider Demographics
NPI:1467474551
Name:LAKEVIEW PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:LAKEVIEW PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HITE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:803-433-9001
Mailing Address - Street 1:122 N BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3253
Mailing Address - Country:US
Mailing Address - Phone:803-433-9001
Mailing Address - Fax:803-433-9002
Practice Address - Street 1:122 N BROOKS ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3253
Practice Address - Country:US
Practice Address - Phone:803-433-9001
Practice Address - Fax:803-433-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q331538524Medicare Oscar/Certification
SC8524Medicare PIN