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General NPI Number Information
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NPI Number | 1881831170
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Entity Type | Organization
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Legal Business Name | THERATAGE REHAB SERVICES, INC.
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 6 FELHURST CT
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-6546
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Country | US
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Telephone | 864-567-5969
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Fax | 864-288-2277
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Provider Business Mailing Address
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Address Line | 6 FELHURST CT
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-6546
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Country | US
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Telephone | 864-567-5969
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Fax | 864-288-2277
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Authorized Official
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Title or Position | CEO
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Name | MR. RICHARD THOMAS JELETIC II
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Credential | MPT
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Telephone | 864-567-5969
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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 | 5477
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License Number State | SC
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