Healthcare Provider Details

I. General information

NPI: 1124076807
Provider Name (Legal Business Name): AMBER T. REEVES P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E QUEEN ST
PENDLETON SC
29670-1721
US

IV. Provider business mailing address

315 E QUEEN ST
PENDLETON SC
29670-1721
US

V. Phone/Fax

Practice location:
  • Phone: 864-403-2000
  • Fax:
Mailing address:
  • Phone: 864-403-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2554
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: