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General NPI Number Information
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NPI Number | 1245370725
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Entity Type | Organization
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Legal Business Name | LOWCOUNTRY REHAB
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 103 3RD ST E
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City | HAMPTON
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State | SC
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Zip | 29924-2511
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Country | US
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Telephone | 803-943-3914
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Fax | 803-943-5131
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Provider Business Mailing Address
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Address Line | 103 3RD ST E
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City | HAMPTON
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State | SC
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Zip | 29924-2511
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Country | US
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Telephone | 803-943-3914
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Fax | 803-943-5131
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | RACHEL PENDARVIS WIGGINS
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Credential | PT, MHS
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Telephone | 803-943-3914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 21659
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License Number State | SC
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