NPIMap

Organization Active NPI

Acker Physical Therapy

  • Physical Therapy Clinic/Center
  • Columbia, SC
National Provider Identifier
1245772755
Registry record updated Jul 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
1580 Issued in SC
Legal business name
ACKER PHYSICAL THERAPY
Practice address
144 Leisure LN Ste 100
Columbia, SC 29210-4156
Phone
(803) 331-3682
Fax
(803) 791-3862
NPI assigned
Nov 15, 2016
Last updated
Jul 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2019

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

Authorized official

Name
Shannon Danese Lott
Title
Billing/Credentialing Manager
Phone
(803) 667-1819

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 5266 SC
Physical Therapy Clinic/Center 261QP2000X 1580 SC Primary

Addresses

Primary practice location

144 Leisure LN Ste 100
Columbia, SC 29210-4156

Mailing address

144 Leisure LN Ste 100
Columbia, SC 29210-4156
Phone (803) 888-6125

Other identifiers 1

IdentifierTypeStateIssuer
1528364734OtherSCPERSONAL NPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190513000445 SC Part B Supplier - Clinic/Group Practice 8325381411 Receives reassigned benefits from 10 practitioners
Practice locations: Columbia, SC

National Provider Directory

National Provider Directory

Locations

144 Leisure Ln
Ste 100
Columbia, SC 29210
Phone (803) 708-3950

Practitioners & affiliated clinicians

Practitioners 11

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": "1479168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564012800000",
    "number": "1245772755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 LEISURE LN STE 100",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292104156",
            "telephone_number": "803-888-6125",
            "fax_number": "803-888-6085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 LEISURE LN STE 100",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292104156",
            "telephone_number": "803-331-3682",
            "fax_number": "803-791-3862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACKER PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-15",
        "last_updated": "2019-07-25",
        "status": "A",
        "authorized_official_last_name": "LOTT",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "DANESE",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "803-667-1819"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "SC",
            "license": "5266",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "SC",
            "license": "1580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI",
            "identifier": "1528364734",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; 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.