NPIMap

Organization Active NPI

Senior Rehab Source

  • Physical Therapist
  • Spartanburg, SC
National Provider Identifier
1043464118
Registry record updated Mar 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4711 Issued in SC
Legal business name
SENIOR REHAB SOURCE
Practice address
2902 E Main Street Ext
Spartanburg, SC 29307-1252
Phone
(864) 266-3536
NPI assigned
Nov 15, 2008
Last updated
Mar 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chris Hoffman
Title
President
Phone
(864) 266-3536

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 4711 SC Primary

Addresses

Primary practice location

2902 E Main Street Ext
Spartanburg, SC 29307-1252

Mailing address

2902 E Main Street Ext
Spartanburg, SC 29307-1252
Phone (864) 266-3536

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090120000574 SC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0941363808 Receives reassigned benefits from 6 practitioners
Practice locations: Clinton, SC; Duncan, SC; Greenville, SC; Greer, SC; Lyman, SC; Spartanburg, SC; Boiling Springs, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238025600000",
    "number": "1043464118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2902 E MAIN STREET EXT",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071252",
            "telephone_number": "864-266-3536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2902 E MAIN STREET EXT",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071252",
            "telephone_number": "864-266-3536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR REHAB SOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-15",
        "last_updated": "2009-03-26",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-266-3536"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "4711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.