Provider Demographics
NPI:1669432993
Name:ABBOTT, JAMES ROBIN JR (RPT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBIN
Last Name:ABBOTT
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0620Medicaid
SCD379OtherMEDICARE PTAN
SCD379OtherMEDICARE PTAN
SCTH0620Medicaid