MEDICARE: CRUNK PHYSICAL THERAPY

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	2251X0800X	Orthopedic Physical Therapist	5100	SC

General Provider Information

NPI Number	:	1659314532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRUNK PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	105A REGENCY COMMONS DR
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-5210
Country	:	US
Telephone Number	:	864-373-9520
Fax Number	:	864-373-9522

Provider Business Practice Location Address
First Line	:	105A REGENCY COMMONS DR
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-5210
Country	:	US
Telephone Number	:	864-373-9520
Fax Number	:	864-237-3952

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. GWEN I JONES
Credential	:
Telephone Number	:	864-373-9520

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	10/06/2008

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Directions to “CRUNK PHYSICAL THERAPY ” Practice Location

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