1508972712 NPI number — NORTH GROVE PHYSICAL THERAPY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508972712 NPI number — NORTH GROVE PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH GROVE PHYSICAL THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508972712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1330 BOILING SPRINGS RD
Provider Second Line Business Mailing Address:
SUITE 1600B
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29303-4201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-582-0019
Provider Business Mailing Address Fax Number:
864-582-2160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 BOILING SPRINGS RD
Provider Second Line Business Practice Location Address:
SUITE 1600B
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29303-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-582-0019
Provider Business Practice Location Address Fax Number:
864-582-2160
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRONEBERGER
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
864-585-8474

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  569 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8636 . This is a "SC MEDICARE PROVIDER #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: DF4478 . This is a "SC RAILROAD PROVIDER #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com