Provider Demographics
NPI:1730137506
Name:KINMARTIN, BRIAN PATRICK (DPT,MTC,OCS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PATRICK
Last Name:KINMARTIN
Suffix:
Gender:M
Credentials:DPT,MTC,OCS
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:P
Other - Last Name:KINMARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, MTC, OCS, OCS
Mailing Address - Street 1:PO BOX 2397
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-2397
Mailing Address - Country:US
Mailing Address - Phone:843-318-6007
Mailing Address - Fax:843-235-0242
Practice Address - Street 1:38 BUSINESS CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7425
Practice Address - Country:US
Practice Address - Phone:843-235-0200
Practice Address - Fax:843-235-0242
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00223985OtherRAILROAD MEDICARE PROFESSIONAL REHABILITATION SERVICES INC
SCTH0839Medicaid
SCP01245610OtherRAILROAD MEDICARE PRS 4 LLC
SCP00223985OtherRAILROAD MEDICARE PROFESSIONAL REHABILITATION SERVICES INC
SCQ335189403Medicare PIN
SCTH0839Medicaid
SCQ33518C630Medicare PIN
SCQ33518A382Medicare PIN