=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730664970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | P&T THERAPY GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2018
-----------------------------------------------------
Last Update Date | 10/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 989 WATER ST
-----------------------------------------------------
City | ALLENDALE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29810-3413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-634-0735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 373
-----------------------------------------------------
City | ALLENDALE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29810-0373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-634-0735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KATHERINE ELIZABETH THARIN
-----------------------------------------------------
Credential | M ED.
-----------------------------------------------------
Telephone | 803-634-0735
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------