MEDICARE: PALMETTO PHYSICAL MEDICINE

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	111NS0005X	Sports Physician Chiropractor	1323	SC
2	207Q00000X	Family Medicine Physician	SC28333	SC

General Provider Information

NPI Number	:	1760674261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO PHYSICAL MEDICINE

Provider Business Mailing Address
First Line	:	PO BOX 10005
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29731
Country	:	US
Telephone Number	:	803-325-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	237 S HERLONG AVE
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1159
Country	:	US
Telephone Number	:	803-325-2200
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. CHRISTINE M MASSIE
Credential	:
Telephone Number	:	803-325-2200

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	08/17/2007

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Directions to “PALMETTO PHYSICAL MEDICINE ” Practice Location

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