Provider Demographics
NPI:1972547743
Name:COMMUNITY REHAB AND PHYSICAL THERAPY, PA
Entity type:Organization
Organization Name:COMMUNITY REHAB AND PHYSICAL THERAPY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:843-347-2970
Mailing Address - Street 1:117 WACCAMAW MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8902
Mailing Address - Country:US
Mailing Address - Phone:843-347-2970
Mailing Address - Fax:843-347-2975
Practice Address - Street 1:117 WACCAMAW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8902
Practice Address - Country:US
Practice Address - Phone:843-347-2970
Practice Address - Fax:843-347-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2629208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1450Medicaid
SCTH1450Medicaid