Provider Demographics
NPI:1700993474
Name:BATES, RICHARD (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BATES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BEN CASEY DRIVE
Mailing Address - Street 2:SUITE 127
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8561
Mailing Address - Country:US
Mailing Address - Phone:803-802-5855
Mailing Address - Fax:803-802-5869
Practice Address - Street 1:105 BEN CASEY DRIVE
Practice Address - Street 2:STE 127
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8561
Practice Address - Country:US
Practice Address - Phone:803-802-5855
Practice Address - Fax:803-802-5869
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4586Medicaid