Provider Demographics
NPI:1376658542
Name:THE SIGURD CENTER FOR ORTHO & NEURO REHAB
Entity type:Organization
Organization Name:THE SIGURD CENTER FOR ORTHO & NEURO REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RPT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:803-926-7204
Mailing Address - Street 1:1311 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-6320
Mailing Address - Country:US
Mailing Address - Phone:803-414-2291
Mailing Address - Fax:803-926-7206
Practice Address - Street 1:1900 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5932
Practice Address - Country:US
Practice Address - Phone:803-926-7204
Practice Address - Fax:803-926-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3101225100000X
SC3111225100000X
SC3021225100000X
SC2387225X00000X
SC2898225X00000X
SC2201225X00000X
SC2682225X00000X
SC3014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8450Medicare PIN