Provider Demographics
NPI:1215939574
Name:SCORE SPORTSMEDICINE LLC
Entity type:Organization
Organization Name:SCORE SPORTSMEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:A
Authorized Official - Last Name:KREPFLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-682-4325
Mailing Address - Street 1:2 MARSHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2305
Mailing Address - Country:US
Mailing Address - Phone:843-682-4325
Mailing Address - Fax:
Practice Address - Street 1:2 MARSHLAND RD
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2305
Practice Address - Country:US
Practice Address - Phone:843-682-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ337428318OtherINDIVIDUAL MEDICARE PIN
SC8318Medicare PIN