Basic Information
| Provider Information | |||||||||
| NPI: | 1275939894 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRESCENT PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2909 | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291162909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039375489 | ||||||||
| FaxNumber: | 8039375492 | ||||||||
| Practice Location | |||||||||
| Address1: | 1180 BOULEVARD STREET | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039375489 | ||||||||
| FaxNumber: | 8039375492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2014 | ||||||||
| LastUpdateDate: | 12/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | KILGUS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8039375489 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 6954 | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.