Provider Demographics
NPI:1396241865
Name:PAR PT, LLC
Entity type:Organization
Organization Name:PAR PT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:GARAVITO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:843-999-0284
Mailing Address - Street 1:605 APOSTLE CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-5543
Mailing Address - Country:US
Mailing Address - Phone:843-855-0679
Mailing Address - Fax:
Practice Address - Street 1:4125 DICK POND RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6807
Practice Address - Country:US
Practice Address - Phone:843-999-0284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy