Provider Demographics
NPI:1427087113
Name:HARTSVILLE PHYSICAL THERAPY & REHABILITATION CENTER LLC.
Entity type:Organization
Organization Name:HARTSVILLE PHYSICAL THERAPY & REHABILITATION CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:SALAMANCA
Authorized Official - Last Name:STO.DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-857-4343
Mailing Address - Street 1:107 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4105
Mailing Address - Country:US
Mailing Address - Phone:843-857-4343
Mailing Address - Fax:843-857-4345
Practice Address - Street 1:107 N 8TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4105
Practice Address - Country:US
Practice Address - Phone:843-857-4343
Practice Address - Fax:843-857-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3280225100000X
SC2899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3924Medicaid
SCGP3924Medicaid