Healthcare Provider Details

I. General information

NPI: 1376658542
Provider Name (Legal Business Name): THE SIGURD CENTER FOR ORTHO & NEURO REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SUNSET BLVD
WEST COLUMBIA SC
29169-5932
US

IV. Provider business mailing address

1311 AUGUSTA RD
WEST COLUMBIA SC
29169-6320
US

V. Phone/Fax

Practice location:
  • Phone: 803-926-7204
  • Fax: 803-926-7206
Mailing address:
  • Phone: 803-414-2291
  • Fax: 803-926-7206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3101
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3111
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3021
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2387
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2898
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2201
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2682
License Number StateSC
# 8
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3014
License Number StateSC

VIII. Authorized Official

Name: MRS. KIRSTEN JORDAN THOMPSON
Title or Position: OWNER/RPT
Credential: RPT
Phone: 803-926-7204