Pro Form Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5186 Issued in SC

Legal business name

PRO FORM THERAPY, LLC

Practice address

1109 S 5TH St
Hartsville, SC 29550-5797

Phone

(843) 861-2127

NPI assigned

Jan 7, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Allen Michael Brown, MPT, MBANPI 1336297456

Title

Physical Therapist

Phone

(843) 861-2127

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Allen Michael Brown, MPT, MBA

  • Physical Therapist
  • Hartsville, SC
  • NPI 1336297456
  NPD (past) Authorized official

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

{
    "created_epoch": "1168128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679621874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 COLONY RD",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295507976",
            "telephone_number": "843-861-2127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 S 5TH ST",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295505797",
            "telephone_number": "843-861-2127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO FORM THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "843-861-2127",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT, MBA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "5186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premise Health of South Carolina Medical PC (Sonoco Health Connection)
• Prestwood Radiology, LLP
• Daronda Price
• Sharla Bush Price, D.M.D.
• Primary Care of Hartsville
• Professional Way Healthcare Staffing, LLC
• Providence Cardiology LLC (South Carolina Heart Center)
• Andrea D Pulling
• Quality Rehabilitation Services LLC
• Elizabeth Bell Quinn

• Physical Therapist in Hartsville, SC
• Providers in Hartsville, SC by specialty
• Physical Therapist in South Carolina

• 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.