MEDICARE: PINNACLE PHYSCIAL THERAPY AND REHAB SPECIALISTS

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	225100000X	Physical Therapist	4318	SC

General Provider Information

NPI Number	:	1871775510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE PHYSCIAL THERAPY AND REHAB SPECIALISTS

Provider Business Mailing Address
First Line	:	PO BOX 3497
Second Line	:
City	:	STURTEVANT
State	:	WI
Zip	:	53177-0300
Country	:	US
Telephone Number	:	877-552-2996
Fax Number	:	866-245-8064

Provider Business Practice Location Address
First Line	:	2313 NORTH BELTLINE BOULEVARD
Second Line	:	SUITE C, D
City	:	FOREST ACRES
State	:	SC
Zip	:	29204
Country	:	US
Telephone Number	:	877-552-2996
Fax Number	:	866-245-8064

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY BRIAND
Credential	:
Telephone Number	:	877-552-2996

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	07/03/2010

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