Healthcare Provider Details

I. General information

NPI: 1265899652
Provider Name (Legal Business Name): VERTEX PT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 12TH ST
CAYCE SC
29033-3304
US

IV. Provider business mailing address

1105 12TH ST
CAYCE SC
29033-3304
US

V. Phone/Fax

Practice location:
  • Phone: 803-973-0100
  • Fax: 803-973-0117
Mailing address:
  • Phone: 803-973-0100
  • Fax: 803-973-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON VAUGHN
Title or Position: CEO
Credential: DPT
Phone: 803-973-0100