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General NPI Number Information
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NPI Number | 1407821911
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Entity Type | Organization
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Legal Business Name | PERSONAL THERAPY INC
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Dates
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Enumeration Date | 02/19/2006
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 823 S OLD FAIRVIEW RD
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City | FOUNTAIN INN
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State | SC
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Zip | 29644-9726
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Country | US
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Telephone | 864-871-1478
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Fax | 864-243-2428
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Provider Business Mailing Address
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Address Line | 823 S OLD FAIRVIEW RD
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City | FOUNTAIN INN
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State | SC
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Zip | 29644-9726
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Country | US
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Telephone | 864-871-1478
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Fax | 864-243-2428
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Authorized Official
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Title or Position | OWNER
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Name | MS. REBECCA C BROWN
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Credential | PT
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Telephone | 864-871-1478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1607
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License Number State | SC
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