Provider Demographics
NPI:1972364016
Name:PALMETTO RESTORATIVE THERAPY
Entity type:Organization
Organization Name:PALMETTO RESTORATIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-345-2814
Mailing Address - Street 1:247 CAMBER RD
Mailing Address - Street 2:
Mailing Address - City:HUGER
Mailing Address - State:SC
Mailing Address - Zip Code:29450-8525
Mailing Address - Country:US
Mailing Address - Phone:843-345-2814
Mailing Address - Fax:
Practice Address - Street 1:247 CAMBER RD
Practice Address - Street 2:
Practice Address - City:HUGER
Practice Address - State:SC
Practice Address - Zip Code:29450-8525
Practice Address - Country:US
Practice Address - Phone:843-345-2814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty