Healthcare Provider Details

I. General information

NPI: 1578596037
Provider Name (Legal Business Name): VICTOR M CORTINA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 TANDEM ROAD
GREER SC
29650-4726
US

IV. Provider business mailing address

320 TANDEM DR
GREER SC
29650-4726
US

V. Phone/Fax

Practice location:
  • Phone: 864-752-3357
  • Fax: 864-752-3347
Mailing address:
  • Phone: 864-655-7757
  • Fax: 864-655-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3658
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: