Healthcare Provider Details

I. General information

NPI: 1558134825
Provider Name (Legal Business Name): UNIVERSAL THERAPY & TESTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 SPARKLEBERRY LANE EXT
COLUMBIA SC
29223-7078
US

IV. Provider business mailing address

112 UPLAND TRAIL RD
ELGIN SC
29045-8251
US

V. Phone/Fax

Practice location:
  • Phone: 803-553-8960
  • Fax:
Mailing address:
  • Phone: 803-553-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KANAN ANAND JANI
Title or Position: VP OF OPERATIONS
Credential: PT,D-EDX
Phone: 803-553-8960