Provider Demographics
NPI:1881663300
Name:PALMETTO REHAB OF CHARLESTON LLC
Entity Type:Organization
Organization Name:PALMETTO REHAB OF CHARLESTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-875-2959
Mailing Address - Street 1:PO BOX 51989
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-1989
Mailing Address - Country:US
Mailing Address - Phone:843-875-2959
Mailing Address - Fax:843-875-2836
Practice Address - Street 1:90 SPRINGVIEW LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8153
Practice Address - Country:US
Practice Address - Phone:843-875-2959
Practice Address - Fax:843-875-2836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7994Medicare ID - Type Unspecified