Healthcare Provider Details

I. General information

NPI: 1821158379
Provider Name (Legal Business Name): UPSTATE MEDICAL REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 GROVE RD SUITE E
GREENVILLE SC
29605-4626
US

IV. Provider business mailing address

1003 GROVE RD SUITE E
GREENVILLE SC
29605-4626
US

V. Phone/Fax

Practice location:
  • Phone: 864-232-8417
  • Fax: 864-232-1511
Mailing address:
  • Phone: 864-232-8417
  • Fax: 864-232-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBBIE J UNDERWOOD
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 864-232-8417