Basic Information
| Provider Information | |||||||||
| NPI: | 1295317857 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACESO PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 RIVERVIEW TER | ||||||||
| Address2: | |||||||||
| City: | LAKE WYLIE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297108964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036932188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 222 RIVERVIEW TER | ||||||||
| Address2: | |||||||||
| City: | LAKE WYLIE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297108964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036932188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2021 | ||||||||
| LastUpdateDate: | 04/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | WHITROW | ||||||||
| AuthorizedOfficialFirstName: | JODI | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER,PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8036932188 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
| NPICertificationDate: | 04/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.