Provider Demographics
NPI:1720092026
Name:BACHOUR, ROGER (PT)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:
Last Name:BACHOUR
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 1:77 POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3505
Mailing Address - Country:US
Mailing Address - Phone:864-233-4477
Mailing Address - Fax:864-233-7844
Practice Address - Street 1:77 POINTE CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3505
Practice Address - Country:US
Practice Address - Phone:864-233-4477
Practice Address - Fax:864-233-7844
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1887208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0739Medicaid
SCTH0739Medicaid