MEDICARE: ENHANCE REHABILITATION, LLC

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	225X00000X	Occupational Therapist	3200	SC
2	225X00000X	Occupational Therapist	4082	SC
3	225100000X	Physical Therapist	5126	SC

General Provider Information

NPI Number	:	1306253406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENHANCE REHABILITATION, LLC

Provider Business Mailing Address
First Line	:	1469 APPLING DR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-4688
Country	:	US
Telephone Number	:	843-614-7429
Fax Number	:	843-225-7885

Provider Business Practice Location Address
First Line	:	1469 APPLING DR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-4688
Country	:	US
Telephone Number	:	843-614-7429
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSHUA C LONG
Credential	:	PT
Telephone Number	:	843-614-7429

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	11/30/2014

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