Provider Demographics
NPI:1609211671
Name:LIBERTY PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:LIBERTY PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:GIAO
Authorized Official - Middle Name:LAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-634-6982
Mailing Address - Street 1:616 EDGEFIELD RD STE 150
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-6407
Mailing Address - Country:US
Mailing Address - Phone:803-634-6982
Mailing Address - Fax:
Practice Address - Street 1:616 EDGEFIELD RD STE 150
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-6407
Practice Address - Country:US
Practice Address - Phone:803-634-6982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6979261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy