Basic Information
| Provider Information | |||||||||
| NPI: | 1952555971 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPORTS PLUS PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 93B SPRINGVIEW LN | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294858154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438754770 | ||||||||
| FaxNumber: | 8438754396 | ||||||||
| Practice Location | |||||||||
| Address1: | 93B SPRINGVIEW LN | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294858154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438754770 | ||||||||
| FaxNumber: | 8438754396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2008 | ||||||||
| LastUpdateDate: | 11/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | MYERS | ||||||||
| AuthorizedOfficialFirstName: | KATHLYNN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 8438754770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 2237 | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.