Provider Demographics
NPI:1851162739
Name:DRE HOLDING CO LLC
Entity Type:Organization
Organization Name:DRE HOLDING CO LLC
Other - Org Name:PHYSIOFUNCTION PT & PERFORMANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:803-816-0136
Mailing Address - Street 1:100 OLD CHEROKEE RD STE F260
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9316
Mailing Address - Country:US
Mailing Address - Phone:803-816-0136
Mailing Address - Fax:
Practice Address - Street 1:857 MALLARD LAKES DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7572
Practice Address - Country:US
Practice Address - Phone:803-816-0136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty