Provider Demographics
NPI:1720812670
Name:PIVOTAL HEALTH AND REHAB LLC
Entity type:Organization
Organization Name:PIVOTAL HEALTH AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-254-4699
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-0008
Mailing Address - Country:US
Mailing Address - Phone:803-254-4699
Mailing Address - Fax:803-851-1235
Practice Address - Street 1:120 HIGHLAND CENTER DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9127
Practice Address - Country:US
Practice Address - Phone:803-254-4699
Practice Address - Fax:803-851-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty