MEDICARE: SOUTHERN STATES PHYSICAL MEDICINE AND REHABILITATION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2158	SC
2	225100000X	Physical Therapist	5224	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023067014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN STATES PHYSICAL MEDICINE AND REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	1002 N WOODLAND DR
Second Line	:
City	:	LANCASTER
State	:	SC
Zip	:	29720-1966
Country	:	US
Telephone Number	:	803-283-8442
Fax Number	:	803-286-4604

Provider Business Practice Location Address
First Line	:	1002 N WOODLAND DR
Second Line	:
City	:	LANCASTER
State	:	SC
Zip	:	29720-1966
Country	:	US
Telephone Number	:	803-283-8442
Fax Number	:	803-286-4604

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PAM JAMES
Credential	:
Telephone Number	:	803-283-8442

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	09/11/2025

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