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General NPI Number Information
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NPI Number | 1912300971
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Entity Type | Organization
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Legal Business Name | GROUPHAB
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 10/06/2014
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Provider Practice Location Address
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Address Line | 30 HOWARD CREEK DR
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City | FOUNTAIN INN
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State | SC
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Zip | 29644-1318
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Country | US
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Telephone | 864-525-2654
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Fax |
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Provider Business Mailing Address
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Address Line | 205 SHADOWBROOKE CT
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-5184
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Country | US
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Telephone | 864-525-2654
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Fax |
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Authorized Official
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Title or Position | OWNER, FOUNDER, PHYSICAL THERAPIST
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Name | PATRICE RENEE HAZAN
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Credential |
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Telephone | 864-525-2654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 3027
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License Number State | SC
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