Healthcare Provider Details

I. General information

NPI: 1558653196
Provider Name (Legal Business Name): SOUTH AIKEN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 PINE LOG RD
AIKEN SC
29803
US

IV. Provider business mailing address

943 PINE LOG RD
AIKEN SC
29803-7330
US

V. Phone/Fax

Practice location:
  • Phone: 803-649-9797
  • Fax: 803-642-2759
Mailing address:
  • Phone: 803-649-9797
  • Fax: 803-642-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7668
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN STURGILL
Title or Position: OFFICE MANAGER
Credential:
Phone: 803-649-9797