Provider Demographics
NPI:1821474115
Name:PRO-MOTION PHYSICAL THERAPY OF FLORENCE, SC, LLC
Entity Type:Organization
Organization Name:PRO-MOTION PHYSICAL THERAPY OF FLORENCE, SC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:IMBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-233-1366
Mailing Address - Street 1:PO BOX 6526
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29260-6526
Mailing Address - Country:US
Mailing Address - Phone:803-693-5040
Mailing Address - Fax:803-233-1367
Practice Address - Street 1:148 B SAULS STREET
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560
Practice Address - Country:US
Practice Address - Phone:843-374-0185
Practice Address - Fax:843-374-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty