Healthcare Provider Details

I. General information

NPI: 1326084849
Provider Name (Legal Business Name): THREE RIVERS THERAPY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MAIN ST SUITE B
HEMINGWAY SC
29554-9191
US

IV. Provider business mailing address

401 N MAIN ST SUITE B
HEMINGWAY SC
29554-9191
US

V. Phone/Fax

Practice location:
  • Phone: 843-558-4830
  • Fax: 843-558-7752
Mailing address:
  • Phone: 843-558-4830
  • Fax: 843-558-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateSC

VIII. Authorized Official

Name: MRS. STACEY L HOWELL
Title or Position: OWNER
Credential: PT
Phone: 843-558-4830