NPIMap

Organization Active NPI

Upstate Physical Therapy

  • Physical Therapist
  • Anderson, SC
National Provider Identifier
1568410751
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
UPSTATE PHYSICAL THERAPY
Practice address
120 Mutual Dr
Anderson, SC 29621
Phone
(864) 261-3313
Fax
(864) 261-3371
NPI assigned
May 4, 2006
Last updated
Mar 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Authorized official

Name
Mr. David Lee Keese, PTNPI 1609824887
Title
Co-Owner
Phone
(864) 261-3313

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: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

120 Mutual Dr
Anderson, SC 29621

Mailing address

120 Mutual Drive
Anderson, SC 29621
Phone (864) 261-3313

Other identifiers 1

IdentifierTypeStateIssuer
8340OtherSCMEDICARE ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050930000126 SC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0345275178 Receives reassigned benefits from 7 practitioners
Practice locations: Anderson, SC

National Provider Directory

National Provider Directory

Locations

1823 E Greenville St
Ste A
Anderson, SC 29621
Phone (864) 261-3313

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1568410751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MUTUAL DRIVE",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "29621",
            "telephone_number": "864-261-3313",
            "fax_number": "864-261-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MUTUAL DR",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "29621",
            "telephone_number": "864-261-3313",
            "fax_number": "864-261-3371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A",
        "authorized_official_last_name": "KEESE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "864-261-3313",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "8340",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anderson, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; 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.