Provider Demographics
NPI:1710430657
Name:PINNACLE PHYSICAL THERAPY & PERSONAL TRAINING, LLC
Entity Type:Organization
Organization Name:PINNACLE PHYSICAL THERAPY & PERSONAL TRAINING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:803-726-0309
Mailing Address - Street 1:3250 FOREST DR
Mailing Address - Street 2:SUITE 50
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4023
Mailing Address - Country:US
Mailing Address - Phone:803-726-0309
Mailing Address - Fax:803-726-0390
Practice Address - Street 1:3250 FOREST DR
Practice Address - Street 2:SUITE 50
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4023
Practice Address - Country:US
Practice Address - Phone:803-726-0309
Practice Address - Fax:803-726-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty