Provider Demographics
NPI:1477508455
Name:ATLANTIC PHYSICAL THERAPY & REHABILITATION, INC.
Entity Type:Organization
Organization Name:ATLANTIC PHYSICAL THERAPY & REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION & CLIENT
Authorized Official - Prefix:
Authorized Official - First Name:DARGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-293-7713
Mailing Address - Street 1:4012 POSTAL WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3185
Mailing Address - Country:US
Mailing Address - Phone:843-903-4940
Mailing Address - Fax:
Practice Address - Street 1:4012 POSTAL WAY
Practice Address - Street 2:SUITE C
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-3185
Practice Address - Country:US
Practice Address - Phone:843-903-4940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0292Medicaid
SCGP0292Medicaid