Provider Demographics
NPI:1255755369
Name:ABBOTT REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:ABBOTT REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPT
Authorized Official - Phone:803-286-5541
Mailing Address - Street 1:PO BOX 2408
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721-2408
Mailing Address - Country:US
Mailing Address - Phone:803-286-5541
Mailing Address - Fax:803-223-7329
Practice Address - Street 1:1318 HIGHWAY 9 BYP W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-4712
Practice Address - Country:US
Practice Address - Phone:803-286-5541
Practice Address - Fax:803-223-7329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD379OtherMEDICARE PTAN