Provider Demographics
NPI:1952552259
Name:PALMETTO THERAPY GROUP, LLC
Entity Type:Organization
Organization Name:PALMETTO THERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:843-245-3561
Mailing Address - Street 1:3321 W DOGWOOD CHASE CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8040
Mailing Address - Country:US
Mailing Address - Phone:843-245-3561
Mailing Address - Fax:800-669-1249
Practice Address - Street 1:3321 W DOGWOOD CHASE CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8040
Practice Address - Country:US
Practice Address - Phone:843-245-3561
Practice Address - Fax:800-669-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation