Provider Demographics
NPI:1629155023
Name:CAROLINA PHYSICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:CAROLINA PHYSICAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:864-229-2663
Mailing Address - Street 1:102 GREGOR MENDEL CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2315
Mailing Address - Country:US
Mailing Address - Phone:864-229-2663
Mailing Address - Fax:864-227-9510
Practice Address - Street 1:102 GREGOR MENDEL CIR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2315
Practice Address - Country:US
Practice Address - Phone:864-229-2663
Practice Address - Fax:864-227-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4489261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8624OtherMEDICARE PTAN
SC000071507Medicaid
SCDN2576OtherRAILROAD MEDICARE GROUP PTAN
SC000071507Medicaid
SCQ334578624Medicare PIN