Healthcare Provider Details

I. General information

NPI: 1053802330
Provider Name (Legal Business Name): PRS 7, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 OAKHEART RD
MYRTLE BEACH SC
29579-1253
US

IV. Provider business mailing address

PO BOX 2397
PAWLEYS ISLAND SC
29585-2397
US

V. Phone/Fax

Practice location:
  • Phone: 843-282-0440
  • Fax: 843-353-2060
Mailing address:
  • Phone: 843-235-0200
  • Fax: 843-235-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3690
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. MELISSA KINMARTIN
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 843-282-0440