Healthcare Provider Details

I. General information

NPI: 1104744770
Provider Name (Legal Business Name): KAITLYN RAE HUMMEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W PALMETTO ST
FLORENCE SC
29501-4302
US

IV. Provider business mailing address

PO BOX 6526
COLUMBIA SC
29260-6526
US

V. Phone/Fax

Practice location:
  • Phone: 843-407-0377
  • Fax: 843-799-1944
Mailing address:
  • Phone: 803-693-5040
  • Fax: 803-993-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13404
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: