Provider Demographics
NPI:1659518975
Name:VISIO PERSPECTIVES NEURO REHAB SERVICES LLC
Entity Type:Organization
Organization Name:VISIO PERSPECTIVES NEURO REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:843-394-7617
Mailing Address - Street 1:300 THURSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2527
Mailing Address - Country:US
Mailing Address - Phone:843-394-3605
Mailing Address - Fax:843-394-1042
Practice Address - Street 1:115 S MORRIS ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2459
Practice Address - Country:US
Practice Address - Phone:843-394-3605
Practice Address - Fax:843-394-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15812251G0304X
SC1113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty