NPIMap

Organization Active NPI

Sumter Physical Therapy Clinic, LLC

  • Physical Therapist
  • Sumter, SC
National Provider Identifier
1194773945
Registry record updated Jul 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1010723 Issued in SC
Legal business name
SUMTER PHYSICAL THERAPY CLINIC, LLC
Practice address
1185 Wilson Hall Rd
Sumter, SC 29150-1842
Phone
(803) 469-3213
Fax
(803) 469-3233
NPI assigned
May 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2012

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

Authorized official

Name
Mr. Phillip Dean Lowe, PT
Title
Partner
Phone
(843) 662-1234

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 1010723 SC Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 1010723 SC

Addresses

Primary practice location

1185 Wilson Hall Rd
Sumter, SC 29150-1842

Mailing address

507 W Cheves St
Florence, SC 29501-4449
Phone (843) 662-1234

Other identifiers 1

IdentifierTypeStateIssuer
GP2145MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040930000680 SC Part B Supplier - Clinic/Group Practice 1052380599 Receives reassigned benefits from 4 practitioners
Practice locations: Sumter, SC

National Provider Directory

National Provider Directory

Locations

1185 Wilson Hall Rd
Sumter, SC 29150
Phone (803) 469-3213

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343001600000",
    "number": "1194773945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 W CHEVES ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295014449",
            "telephone_number": "843-662-1234",
            "fax_number": "843-669-7144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1185 WILSON HALL RD",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291501842",
            "telephone_number": "803-469-3213",
            "fax_number": "803-469-3233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMTER PHYSICAL THERAPY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2012-07-23",
        "status": "A",
        "authorized_official_last_name": "LOWE",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "843-662-1234",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "1010723",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "1010723",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2145",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sumter, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2012; 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.