# SOUTHERN STATES PHYSICAL THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285024836
- **Authorized official:** MR. RYAN CHRISTOPHER FAKER MSPT (OWNER/PHYSICAL THERAPIST)
- **Authorized official phone:** (704) 578-0641

## Contact information

- **Practice address:** 106A WOODLAND DR, LANCASTER, SC 29720-4707
- **Practice address phone:** (803) 283-8442
- **Practice address fax:** (803) 286-4604
- **Mailing address:** 2670 MILLS PARK DR, ROCK HILL, SC 29732-8599
- **Mailing address phone:** (803) 324-3745
- **Mailing address fax:** (803) 324-9845

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 4533 | SC | Yes |

## Other

- **Enumeration date:** 02/03/2015
- **Last updated:** 08/24/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 13501810 | CAQH | SC |