Healthcare Provider Details

I. General information

NPI: 1972364016
Provider Name (Legal Business Name): PALMETTO RESTORATIVE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 CAMBER RD
HUGER SC
29450-8525
US

IV. Provider business mailing address

247 CAMBER RD
HUGER SC
29450-8525
US

V. Phone/Fax

Practice location:
  • Phone: 843-345-2814
  • Fax:
Mailing address:
  • Phone: 843-345-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: ANDREW TYLER
Title or Position: OWNER
Credential:
Phone: 843-345-2814