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General NPI Number Information
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NPI Number | 1598209728
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Entity Type | Organization
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Legal Business Name | SENIOR PHYSICAL MEDICINE LLC
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 201 HENRY PL
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City | SPARTANBURG
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State | SC
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Zip | 29306-3208
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Country | US
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Telephone | 864-310-6101
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 CLEMSON BLVD STE 17
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City | ANDERSON
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State | SC
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Zip | 29621-1324
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADVISOR
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Name | NICHOLAS WINKLER
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Credential |
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Telephone | 708-275-8518
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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 | 1061
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License Number State | SC
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