Provider Demographics
NPI:1558507285
Name:ATLANTIC PHYSICAL THERAPY AND REHAB, INC.
Entity Type:Organization
Organization Name:ATLANTIC PHYSICAL THERAPY AND REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-293-2129
Mailing Address - Street 1:4310 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4310 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5022
Practice Address - Country:US
Practice Address - Phone:843-293-7713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC PHYSICAL THERAPY AND REHAB, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0292Medicaid
SC426546Medicare PIN