Provider Demographics
NPI:1841689569
Name:CORE POWER REHABILITATION
Entity type:Organization
Organization Name:CORE POWER REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:803-240-5745
Mailing Address - Street 1:810 N EDEN DR
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-2332
Mailing Address - Country:US
Mailing Address - Phone:803-240-5745
Mailing Address - Fax:803-233-8201
Practice Address - Street 1:810 N EDEN DR
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-2332
Practice Address - Country:US
Practice Address - Phone:803-240-5745
Practice Address - Fax:803-233-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC667251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health