Provider Demographics
NPI:1679377428
Name:FLORENCE MYOFASCIAL RELEASE AND PT LLC
Entity type:Organization
Organization Name:FLORENCE MYOFASCIAL RELEASE AND PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DE CASSIA
Authorized Official - Last Name:MARTINS-SKOLNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-229-3061
Mailing Address - Street 1:3810 MASTERS CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8514
Mailing Address - Country:US
Mailing Address - Phone:843-229-3061
Mailing Address - Fax:
Practice Address - Street 1:1210 S CASHUA DR STE 8/9
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5325
Practice Address - Country:US
Practice Address - Phone:843-229-3061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy