Healthcare Provider Details

I. General information

NPI: 1740724210
Provider Name (Legal Business Name): WARREN REHAB GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2016
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 COLLEGE ST
IRMO SC
29063-2903
US

IV. Provider business mailing address

7430 COLLEGE ST
IRMO SC
29063-2903
US

V. Phone/Fax

Practice location:
  • Phone: 803-445-2941
  • Fax: 833-450-0785
Mailing address:
  • Phone: 803-445-2941
  • Fax: 833-450-0785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW JUDD WARREN
Title or Position: PRESIDENT
Credential: PTA
Phone: 803-445-2941