Provider Demographics
NPI:1629367693
Name:GYROTONIC VISTA
Entity Type:Organization
Organization Name:GYROTONIC VISTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:PULLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-758-5962
Mailing Address - Street 1:911 LADY ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3105
Mailing Address - Country:US
Mailing Address - Phone:803-758-5962
Mailing Address - Fax:
Practice Address - Street 1:911 LADY ST
Practice Address - Street 2:SUITE H
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3105
Practice Address - Country:US
Practice Address - Phone:803-758-5962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0724727225500000X, 2255A2300X, 225600000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty