Individual provider Active NPI

Elizabeth Ryan Faircloth, P.T.

  • Physical Therapist
  • Aiken, SC
National Provider Identifier
1255583605
Registry record updated Jun 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5352 Issued in SC
Practice address
943 Pine Log Rd
Aiken, SC 29803
Phone
(803) 649-9797
Fax
(803) 642-2759
NPI assigned
Oct 16, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5352 SC Primary

Addresses

Primary practice location

943 Pine Log Rd
Aiken, SC 29803

Mailing address

943 Pine Log Rd
Aiken, SC 29803-7330
Phone (803) 649-9797

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5352SCMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529366400000",
    "number": "1255583605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "943 PINE LOG RD",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298037330",
            "telephone_number": "803-649-9797",
            "fax_number": "803-642-2759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "943 PINE LOG RD",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "29803",
            "telephone_number": "803-649-9797",
            "fax_number": "803-642-2759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRCLOTH",
        "first_name": "ELIZABETH",
        "middle_name": "RYAN",
        "name_prefix": "Ms.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-16",
        "last_updated": "2018-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "5352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiken, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; 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.