Healthcare Provider Details

I. General information

NPI: 1679124358
Provider Name (Legal Business Name): SOULSHINE PELVIC HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ROSEWOOD DR STE 5
COLUMBIA SC
29205-3433
US

IV. Provider business mailing address

3213 CANNON ST
COLUMBIA SC
29205-3438
US

V. Phone/Fax

Practice location:
  • Phone: 803-784-2464
  • Fax:
Mailing address:
  • Phone: 301-467-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGHAN FRANCES DAVIDSON
Title or Position: OWNER
Credential: PT, DPT
Phone: 803-784-2464