NPIMap

Organization Active NPI

Omni Physical Therapy Inc

  • Physical Therapist
  • Dillon, SC
National Provider Identifier
1316097702
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4705 Issued in SC
Legal business name
OMNI PHYSICAL THERAPY INC
Practice address
126 N Macarthur Ave
Dillon, SC 29536-3434
Phone
(843) 774-7462
Fax
(843) 841-2482
NPI assigned
Jan 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Melissa Keziah Shumate, MPTNPI 1871514182
Title
Physical Therapist
Phone
(843) 409-1620

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 4705 SC Primary

Addresses

Primary practice location

126 N Macarthur Ave
Dillon, SC 29536-3434

Mailing address

1647 Ruby Rd
Hartsville, SC 29550-2407
Phone (843) 409-1620

Other identifiers 1

IdentifierTypeStateIssuer
TH1381MedicaidSC

National Provider Directory

National Provider Directory

Locations

313 W Carolina Ave
Hartsville, SC 29550
Phone (843) 332-7750

Practitioners & affiliated clinicians

Practitioners 6

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": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316097702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1647 RUBY RD",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295502407",
            "telephone_number": "843-409-1620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 N MACARTHUR AVE",
            "city": "DILLON",
            "state": "SC",
            "postal_code": "295363434",
            "telephone_number": "843-774-7462",
            "fax_number": "843-841-2482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHUMATE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "KEZIAH",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "843-409-1620",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "4705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TH1381",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dillon, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.