Provider Demographics
NPI:1679502363
Name:LANCASTER PHYSICAL THERAPY LLC.
Entity Type:Organization
Organization Name:LANCASTER PHYSICAL THERAPY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:SALAMANCA
Authorized Official - Last Name:STO.DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:803-313-9300
Mailing Address - Street 1:1025 W MEETING ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2204
Mailing Address - Country:US
Mailing Address - Phone:803-313-9300
Mailing Address - Fax:803-313-9305
Practice Address - Street 1:1025 W MEETING ST
Practice Address - Street 2:SUITE 106
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2204
Practice Address - Country:US
Practice Address - Phone:803-313-9300
Practice Address - Fax:803-313-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3547Medicaid
SC7438Medicare ID - Type UnspecifiedGROUP NUMBER