Provider Demographics
NPI:1891889259
Name:INDIGO PHYSICAL THERAPY & SPORTS MEDICINE
Entity Type:Organization
Organization Name:INDIGO PHYSICAL THERAPY & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-342-7330
Mailing Address - Street 1:PO BOX 23584
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29925-3584
Mailing Address - Country:US
Mailing Address - Phone:843-342-7330
Mailing Address - Fax:
Practice Address - Street 1:12 LAFAYETTE PL
Practice Address - Street 2:SUITE A
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2209
Practice Address - Country:US
Practice Address - Phone:843-342-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8252Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER