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General NPI Number Information
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NPI Number | 1952555971
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Entity Type | Organization
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Legal Business Name | SPORTS PLUS PHYSICAL THERAPY
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 11/05/2008
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Provider Practice Location Address
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Address Line | 93B SPRINGVIEW LN
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8154
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Country | US
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Telephone | 843-875-4770
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Fax | 843-875-4396
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Provider Business Mailing Address
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Address Line | 93B SPRINGVIEW LN
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8154
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Country | US
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Telephone | 843-875-4770
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Fax | 843-875-4396
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | MRS. KATHLYNN J MYERS
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Credential |
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Telephone | 843-875-4770
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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 | 2237
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License Number State | SC
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