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General NPI Number Information
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NPI Number | 1669487476
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Entity Type | Organization
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Legal Business Name | IN HOME REHAB OF SOUTH CAROLINA LLC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 47 HAVEN RIDGE CT
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City | COLUMBIA
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State | SC
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Zip | 29212-2881
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Country | US
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Telephone | 803-407-3869
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Fax |
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Provider Business Mailing Address
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Address Line | 47 HAVEN RIDGE CT
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City | COLUMBIA
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State | SC
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Zip | 29212-2881
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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 | OWNER
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Name | CRAIG PETERS
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Credential |
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Telephone | 803-407-3869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4267
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License Number State | SC
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