Provider Demographics
NPI:1497703524
Name:ACCELERATED PHYSICAL THERAPY PA
Entity Type:Organization
Organization Name:ACCELERATED PHYSICAL THERAPY PA
Other - Org Name:ACCELERATED PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:864-233-4477
Mailing Address - Street 1:77 POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3505
Mailing Address - Country:US
Mailing Address - Phone:864-233-4477
Mailing Address - Fax:864-233-7844
Practice Address - Street 1:77 POINTE CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3505
Practice Address - Country:US
Practice Address - Phone:864-233-4477
Practice Address - Fax:864-233-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3370Medicaid
SCGP3370Medicaid
SC5285270001Medicare NSC