Healthcare Provider Details

I. General information

NPI: 1184974743
Provider Name (Legal Business Name): CAROLINA WOMEN'S PHYSICAL THERAPY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 FOREST DR STE 101
COLUMBIA SC
29204-4350
US

IV. Provider business mailing address

304 FAVERSHAM CRES
COLUMBIA SC
29229-7003
US

V. Phone/Fax

Practice location:
  • Phone: 803-386-8610
  • Fax:
Mailing address:
  • Phone: 803-386-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5018
License Number StateSC

VIII. Authorized Official

Name: DAWN CHAMBERS-LYNCH
Title or Position: OWNER
Credential:
Phone: 803-386-8610