MEDICARE: PERSONAL THERAPY 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
1	2251P0200X	Pediatric Physical Therapist	1607	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407821911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL THERAPY INC

Provider Business Mailing Address
First Line	:	823 S OLD FAIRVIEW RD
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-9726
Country	:	US
Telephone Number	:	864-871-1478
Fax Number	:	864-243-2428

Provider Business Practice Location Address
First Line	:	823 S OLD FAIRVIEW RD
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-9726
Country	:	US
Telephone Number	:	864-871-1478
Fax Number	:	864-243-2428

Authorized Official
Title or Position	:	OWNER
Name	:	MS. REBECCA C BROWN
Credential	:	PT
Telephone Number	:	864-871-1478

Provider Enumeration Date	:	02/19/2006
Last Update Date	:	05/30/2013

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