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NPI Code Detail

MEDICARE: SPORTS SPINE & INDUSTRIAL, INC.

MEDICARE: SPORTS SPINE & INDUSTRIAL, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistSC

General Provider Information

NPI Number : 1093748121
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPORTS SPINE & INDUSTRIAL, INC.
Provider Business Mailing Address
First Line : 140 EXECUTIVE DR
Second Line :
City : GREER
State : SC
Zip : 29651-1200
Country : US
Telephone Number : 864-801-8706
Fax Number : 864-848-7203
Provider Business Practice Location Address
First Line : 140 EXECUTIVE DR
Second Line :
City : GREER
State : SC
Zip : 29651-1200
Country : US
Telephone Number : 864-801-8706
Fax Number : 864-848-7203
Authorized Official
Title or Position : PHYSICAL THERAPIST/OWNER
Name : MRS. AMANDA TIEDER SOMERS
Credential : PT
Telephone Number : 864-801-8706
Provider Enumeration Date : 07/09/2006
Last Update Date : 07/21/2022

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Directions to “SPORTS SPINE & INDUSTRIAL, INC. ” Practice Location

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