MEDICARE: UNIVERSAL THERAPY & TESTING 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	261QP2000X	Physical Therapy Clinic/Center
2	2251E1300X	Clinical Electrophysiology Physical Therapist

General Provider Information

NPI Number	:	1558134825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL THERAPY & TESTING LLC

Provider Business Mailing Address
First Line	:	112 UPLAND TRAIL RD
Second Line	:
City	:	ELGIN
State	:	SC
Zip	:	29045-8251
Country	:	US
Telephone Number	:	803-553-8960
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 SPARKLEBERRY LANE EXT
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-7078
Country	:	US
Telephone Number	:	803-553-8960
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	KANAN ANAND JANI
Credential	:	PT,D-EDX
Telephone Number	:	803-553-8960

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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