MEDICARE: SAGE REBOTTARO

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	225100000X	Physical Therapist	11387	SC

General Provider Information

NPI Number	:	1184292922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAGE REBOTTARO

Provider Business Mailing Address
First Line	:	1460 JOHN B WHITE SR BLVD STE 1B
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-3996
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 JOHN B WHITE SR BLVD STE 1B
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-3996
Country	:	US
Telephone Number	:	517-349-1110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	08/19/2024

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Directions to “ SAGE REBOTTARO ” Practice Location

Language	Start Address	Practice Location

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