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General NPI Number Information
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NPI Number | 1386338275
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Entity Type | Organization
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Legal Business Name | ORTHO SPORT & SPINE PHYSICIANS FORT MILL
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 1698 HIGHWAY 160 W
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City | FORT MILL
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State | SC
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Zip | 29708-8032
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Country | US
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Telephone | 678-752-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 5788 ROSWELL RD
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City | ATLANTA
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State | GA
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Zip | 30328-4904
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Country | US
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Telephone | 678-752-7246
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Fax |
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Authorized Official
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Title or Position | RCM DIRECTOR
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Name | FAITH A BELTZHOOVER
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Credential |
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Telephone | 678-752-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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