Provider Demographics
NPI:1003194978
Name:PALMETTO REHABILITATION SPECIALISTS, LLC
Entity type:Organization
Organization Name:PALMETTO REHABILITATION SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-802-5855
Mailing Address - Street 1:105 BEN CASEY DR
Mailing Address - Street 2:SUITE 127
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8561
Mailing Address - Country:US
Mailing Address - Phone:803-802-5855
Mailing Address - Fax:803-802-5869
Practice Address - Street 1:105 BEN CASEY DR STE 127
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8557
Practice Address - Country:US
Practice Address - Phone:803-802-5855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4586Medicaid
SCPENDINGOtherALL ARE PENDING
SCPENDINGMedicare UPIN