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General NPI Number Information
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NPI Number | 1386836120
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Entity Type | Organization
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Legal Business Name | PIEDMONT REHABILITATION MEDICINE
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 160 HAROLD FLEMING CT
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City | SPARTANBURG
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State | SC
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Zip | 29303
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Country | US
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Telephone | 864-594-9600
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Fax | 864-594-9823
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Provider Business Mailing Address
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Address Line | PO BOX 678361
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City | DALLAS
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State | TX
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Zip | 75267-8361
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Country | US
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Telephone | 817-284-9850
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Fax | 817-284-3425
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | NIEDRA ROBINSON
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Credential |
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Telephone | 817-284-9850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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 | MD15580
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License Number State | SC
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