=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285859819
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH AIKEN PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 12/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 681 SILVER BLUFF RD STE A
-----------------------------------------------------
City | AIKEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29803-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-649-9797
-----------------------------------------------------
Fax | 803-642-2759
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 681 SILVER BLUFF RD STE A
-----------------------------------------------------
City | AIKEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29803-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-649-9797
-----------------------------------------------------
Fax | 803-642-2759
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. SEAN VINCENT DALY
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 803-649-9797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------