Healthcare Provider Details

I. General information

NPI: 1346507571
Provider Name (Legal Business Name): ENVISION THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CHAPELWOOD DR
COLUMBIA SC
29229-7121
US

IV. Provider business mailing address

118A N BRICKYARD RD
COLUMBIA SC
29223-6902
US

V. Phone/Fax

Practice location:
  • Phone: 803-661-9533
  • Fax:
Mailing address:
  • Phone: 803-897-7022
  • Fax: 803-832-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number4836
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHERRI MCGRAW WICKER
Title or Position: OWNER
Credential: PT
Phone: 803-360-8797