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General NPI Number Information
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NPI Number | 1760674261
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Entity Type | Organization
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Legal Business Name | PALMETTO PHYSICAL MEDICINE
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 237 S HERLONG AVE
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City | ROCK HILL
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State | SC
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Zip | 29732-1159
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Country | US
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Telephone | 803-325-2200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10005
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City | ROCK HILL
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State | SC
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Zip | 29731
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Country | US
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Telephone | 803-325-2200
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. CHRISTINE M MASSIE
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Credential |
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Telephone | 803-325-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 1323
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | SC28333
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License Number State | SC
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