Provider Demographics
NPI:1457961963
Name:MIDLANDS PHYSICAL THERAPY AND WELLNESS LLC.
Entity Type:Organization
Organization Name:MIDLANDS PHYSICAL THERAPY AND WELLNESS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:803-924-3581
Mailing Address - Street 1:115 PETTUS LN
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-7719
Mailing Address - Country:US
Mailing Address - Phone:803-924-3581
Mailing Address - Fax:803-276-9495
Practice Address - Street 1:115 PETTUS LN
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-7719
Practice Address - Country:US
Practice Address - Phone:803-924-3581
Practice Address - Fax:803-276-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy