Provider Demographics
NPI:1215941513
Name:PERSONAL CARE PHYSICAL THERAPY
Entity type:Organization
Organization Name:PERSONAL CARE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SCIBILIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:843-327-6278
Mailing Address - Street 1:19 ARROWHEAD HALL
Mailing Address - Street 2:PERSONAL CARE PHYSICAL THERAPY
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455
Mailing Address - Country:US
Mailing Address - Phone:843-327-6278
Mailing Address - Fax:
Practice Address - Street 1:19 ARROWHEAD HALL
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455
Practice Address - Country:US
Practice Address - Phone:843-327-6278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3301261QP2000X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3301OtherLICENSE NUMBER
SCGP3978Medicaid
SC3301OtherLICENSE NUMBER
SC7747Medicare PIN