Provider Demographics
NPI:1952649956
Name:PRS 4, LLC
Entity Type:Organization
Organization Name:PRS 4, LLC
Other - Org Name:PROFESSIONAL REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:KINMARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MTC, OCS
Authorized Official - Phone:843-235-0200
Mailing Address - Street 1:PO BOX 2397
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-2397
Mailing Address - Country:US
Mailing Address - Phone:843-235-0200
Mailing Address - Fax:843-235-0242
Practice Address - Street 1:4731 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5090
Practice Address - Country:US
Practice Address - Phone:843-314-3224
Practice Address - Fax:843-314-3596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDU2097OtherRAILROAD MEDICARE
SCGP6650Medicaid
SCDU2097OtherRAILROAD MEDICARE