Provider Demographics
NPI:1912292566
Name:TRI-COUNTY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:TRI-COUNTY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHEAFFER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:803-604-1479
Mailing Address - Street 1:2340 CANEY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-8926
Mailing Address - Country:US
Mailing Address - Phone:803-604-1479
Mailing Address - Fax:803-604-1479
Practice Address - Street 1:2340 CANEY BRANCH RD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-8926
Practice Address - Country:US
Practice Address - Phone:803-604-1479
Practice Address - Fax:803-604-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5319261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy