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General NPI Number Information
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NPI Number | 1104145994
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Entity Type | Organization
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Legal Business Name | ISLAND MANUAL & SPORTS PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 6 OUTPOST LN
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City | HILTON HEAD ISLAND
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State | SC
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Zip | 29928-3802
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Country | US
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Telephone | 843-686-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 6 OUTPOST LN
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City | HILTON HEAD ISLAND
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State | SC
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Zip | 29928-3802
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Country | US
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Telephone | 843-686-4000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT E DAYTON
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Credential | PT
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Telephone | 843-686-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4856
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License Number State | SC
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