NPIMap

Organization Active NPI

Fort Mill Spine and Sports Rehab, LLC

  • Chiropractor
  • Fort Mill, SC
National Provider Identifier
1386434074
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
FORT MILL SPINE AND SPORTS REHAB, LLC
Practice address
1096 Assembly Dr Ste 310
Fort Mill, SC 29708-6450
Phone
(803) 547-9800
NPI assigned
May 7, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Authorized official

Name
Fikri Soussi
Title
Owner
Phone
(803) 547-9800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

1096 Assembly Dr Ste 310
Fort Mill, SC 29708-6450

Mailing address

1096 Assembly Dr Ste 310
Fort Mill, SC 29708-6450
Phone (803) 547-9800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250708004409 SC Part B Supplier - Clinic/Group Practice 2961916390 Receives reassigned benefits from 3 practitioners
Practice locations: Fort Mill, SC

National Provider Directory

National Provider Directory

Locations

1096 Assembly Dr
Ste 310
Fort Mill, SC 29708
Phone (803) 547-9800

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1746576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1386434074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1096 ASSEMBLY DR STE 310",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297086450",
            "telephone_number": "803-547-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1096 ASSEMBLY DR STE 310",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297086450",
            "telephone_number": "803-547-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MILL SPINE AND SPORTS REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-07",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A",
        "authorized_official_last_name": "SOUSSI",
        "authorized_official_first_name": "FIKRI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-547-9800"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Mill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; 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.