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General NPI Number Information
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NPI Number | 1346507571
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Entity Type | Organization
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Legal Business Name | ENVISION THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 211 CHAPELWOOD DR
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City | COLUMBIA
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State | SC
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Zip | 29229-7121
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Country | US
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Telephone | 803-661-9533
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Fax |
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Provider Business Mailing Address
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Address Line | 118A N BRICKYARD RD
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City | COLUMBIA
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State | SC
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Zip | 29223-6902
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Country | US
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Telephone | 803-897-7022
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Fax | 803-832-1572
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Authorized Official
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Title or Position | OWNER
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Name | SHERRI MCGRAW WICKER
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Credential | PT
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Telephone | 803-360-8797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 4836
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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