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NPI Code Detail

MEDICARE: ELIZABETH NYBERG PT, DPT

MEDICARE: ELIZABETH NYBERG PT, DPT
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
1225100000XPhysical TherapistSC

General Provider Information

NPI Number : 1104353945
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH NYBERG PT, DPT
Provider Business Mailing Address
First Line : 800 CRESCENT CENTRE DR STE 300
Second Line :
City : FRANKLIN
State : TN
Zip : 37067-7285
Country : US
Telephone Number : 615-373-1350
Fax Number : 615-221-9054
Provider Business Practice Location Address
First Line : 3032 W MONTAGUE AVE STE 101
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29418-7921
Country : US
Telephone Number : 843-885-8772
Fax Number : 843-885-8773
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2017
Last Update Date : 10/03/2019

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