Provider Demographics
NPI:1740487339
Name:JOHN, PAUL MICHAEL (PT, MS, ATC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MICHAEL
Last Name:JOHN
Suffix:
Gender:M
Credentials:PT, MS, ATC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:315 N BELTLINE DR STE D
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-7420
Mailing Address - Country:US
Mailing Address - Phone:843-407-7010
Mailing Address - Fax:843-407-7814
Practice Address - Street 1:315 N BELTLINE DR STE D
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-7420
Practice Address - Country:US
Practice Address - Phone:843-407-7010
Practice Address - Fax:843-407-7814
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43112251S0007X, 2251X0800X
SC4962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer