Provider Demographics
NPI:1881831170
Name:THERATAGE REHAB SERVICES, INC.
Entity Type:Organization
Organization Name:THERATAGE REHAB SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JELETIC
Authorized Official - Suffix:II
Authorized Official - Credentials:MPT
Authorized Official - Phone:864-567-5969
Mailing Address - Street 1:6 FELHURST CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6546
Mailing Address - Country:US
Mailing Address - Phone:864-567-5969
Mailing Address - Fax:864-288-2277
Practice Address - Street 1:6 FELHURST CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-6546
Practice Address - Country:US
Practice Address - Phone:864-567-5969
Practice Address - Fax:864-288-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty