Healthcare Provider Details

I. General information

NPI: 1942266176
Provider Name (Legal Business Name): PALMETTO SPINE & SPORTS MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 ASHLEY TOWN CENTER DR BLGD A-102
CHARLESTON SC
29414-5664
US

IV. Provider business mailing address

3030 ASHLEY TOWN CENTER DR BLGD A-102
CHARLESTON SC
29414-5664
US

V. Phone/Fax

Practice location:
  • Phone: 843-573-9997
  • Fax: 843-377-1446
Mailing address:
  • Phone: 843-573-9997
  • Fax: 843-377-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY MICHAEL ZGLESZEWSKI
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 843-573-9997