Healthcare Provider Details

I. General information

NPI: 1104023738
Provider Name (Legal Business Name): REBECCA FOWLER VEREEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 HIGHWAY 15-401 E STE B
MC COLL SC
29570-6128
US

IV. Provider business mailing address

148 SAULS ST STE B
LAKE CITY SC
29560-2677
US

V. Phone/Fax

Practice location:
  • Phone: 843-894-1141
  • Fax: 843-894-1142
Mailing address:
  • Phone: 843-374-0185
  • Fax: 843-374-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2135
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: