Healthcare Provider Details

I. General information

NPI: 1174201743
Provider Name (Legal Business Name): PALMETTO BILL RITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 RIVEN OAK DR
MURRELLS INLET SC
29576-7749
US

IV. Provider business mailing address

806 RIVEN OAK DR
MURRELLS INLET SC
29576-7749
US

V. Phone/Fax

Practice location:
  • Phone: 843-455-9668
  • Fax: 843-213-6656
Mailing address:
  • Phone: 843-455-9668
  • Fax: 843-213-6656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KAREN BRUNSON FOSTER
Title or Position: CO-OWNER
Credential: RPT
Phone: 843-455-9668