Physical Restoration LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3377 Issued in SC

Legal business name

PHYSICAL RESTORATION LLC

Practice address

452 Lakeshore Pkwy
Suite 230
Rock Hill, SC 29730-4291

Phone

(803) 327-8300

NPI assigned

Aug 29, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Roderick Leighton Peddy, D.C.

Title

Owner

Phone

(803) 327-8300

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1219968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219968000000",
    "number": "1053569285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "452 LAKESHORE PKWY",
            "address_2": "SUITE 230",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297304291",
            "telephone_number": "803-327-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "452 LAKESHORE PKWY",
            "address_2": "SUITE 230",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297304291",
            "telephone_number": "803-327-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL RESTORATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-29",
        "last_updated": "2008-08-29",
        "status": "A",
        "authorized_official_last_name": "PEDDY",
        "authorized_official_first_name": "RODERICK",
        "authorized_official_middle_name": "LEIGHTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-327-8300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "3377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.