Healthcare Provider Details

I. General information

NPI: 1679881882
Provider Name (Legal Business Name): PALMETTO BALANCE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 2ND LOOP RD STE A
FLORENCE SC
29505-2845
US

IV. Provider business mailing address

1506 2ND LOOP RD STE A
FLORENCE SC
29505-2845
US

V. Phone/Fax

Practice location:
  • Phone: 843-661-0211
  • Fax: 843-661-0213
Mailing address:
  • Phone: 843-661-0211
  • Fax: 843-661-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DALE COLE
Title or Position: OWNER/NUTRITIONIST
Credential:
Phone: 843-661-0211