Healthcare Provider Details

I. General information

NPI: 1063632115
Provider Name (Legal Business Name): KAREN P KISSENBERTH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN PRICE

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 GROVE ROAD
GREENVILLE SC
29605
US

IV. Provider business mailing address

103 N MAIN ST STE 300
GREENVILLE SC
29601-2796
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-2319
  • Fax:
Mailing address:
  • Phone: 864-528-5700
  • Fax: 864-528-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1521
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: