NPIMap

Organization Active NPI

Rivertown Lymphedema Clinic and Rehab, LLC

  • Physical Therapy Clinic/Center
  • Myrtle Beach, SC
National Provider Identifier
1306074885
Registry record updated Jun 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
RIVERTOWN LYMPHEDEMA CLINIC AND REHAB, LLC
Practice address
100 Prather Park Dr
Suite a
Myrtle Beach, SC 29588-7910
Phone
(843) 742-5701
Fax
(843) 742-5704
NPI assigned
Jun 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2009

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

Authorized official

Name
Thomas Andrew Kincheloe, OTR/L, CLT
Title
Owner/Administrator
Phone
(843) 742-5701

Specialties & licenses 1

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

Addresses

Primary practice location

100 Prather Park Dr
Suite a
Myrtle Beach, SC 29588-7910

Mailing address

100 Prather Park Dr
Suite a
Myrtle Beach, SC 29588-7910
Phone (843) 742-5701

National Provider Directory

National Provider Directory

Locations

100 Prather Park Dr
#A
Myrtle Beach, SC 29588
Phone (843) 742-5701

Practitioners & affiliated clinicians

Practitioners 3

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": "1245715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245801600000",
    "number": "1306074885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PRATHER PARK DR",
            "address_2": "SUITE A",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295887910",
            "telephone_number": "843-742-5701",
            "fax_number": "843-742-5704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PRATHER PARK DR",
            "address_2": "SUITE A",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295887910",
            "telephone_number": "843-742-5701",
            "fax_number": "843-742-5704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERTOWN LYMPHEDEMA CLINIC AND REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-23",
        "last_updated": "2009-06-24",
        "status": "A",
        "authorized_official_last_name": "KINCHELOE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "843-742-5701",
        "authorized_official_credential": "OTR/L, CLT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2009; 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.