Basic Information
| Provider Information | |||||||||
| NPI: | 1376972109 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIRST PHYSICAL THERAPY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CORA REHABILITATION CLINICS - BATESBURG | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 SHAWNEE RD | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458053529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192216720 | ||||||||
| FaxNumber: | 4192220507 | ||||||||
| Practice Location | |||||||||
| Address1: | 141 E CHURCH ST | ||||||||
| Address2: | SUITE N | ||||||||
| City: | BATESBURG-LEESVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290707066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035323335 | ||||||||
| FaxNumber: | 8035323337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2013 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | ROUSH | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4192216712 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | GP7068 | 05 | SC | MEDICAID |