Basic Information
| Provider Information | |||||||||
| NPI: | 1447536727 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEAH HAMOY LLC | ||||||||
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| OtherOrganizationName: | DYNAMIC PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 CHERAW ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BENNETTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295122422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434540911 | ||||||||
| FaxNumber: | 8434540910 | ||||||||
| Practice Location | |||||||||
| Address1: | 2724 W PALMETTO ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295014909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432921900 | ||||||||
| FaxNumber: | 8432921902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2011 | ||||||||
| LastUpdateDate: | 10/31/2011 | ||||||||
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| AuthorizedOfficialLastName: | HAMOY | ||||||||
| AuthorizedOfficialFirstName: | LEAH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8432921900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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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.