Provider Demographics
NPI:1972257251
Name:PIERCE, PHILLIP (DPT)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 S BONHAM RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-4011
Mailing Address - Country:US
Mailing Address - Phone:180-340-9874
Mailing Address - Fax:
Practice Address - Street 1:1 STILL HOPES DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-7164
Practice Address - Country:US
Practice Address - Phone:803-739-5014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT.9967208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPT.9967OtherSOUTH CAROLINA DEPT OF LABOR, LICENSING, AND REGISTRATION BOARD OF PHYSICAL THER