# RIVERTOWN LYMPHEDEMA CLINIC AND REHAB, LLC

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

## Provider details

- **NPI number:** 1306074885
- **Authorized official:** THOMAS ANDREW KINCHELOE OTR/L, CLT (OWNER/ADMINISTRATOR)
- **Authorized official phone:** (843) 742-5701

## Contact information

- **Practice address:** 100 PRATHER PARK DR, SUITE A, MYRTLE BEACH, SC 29588-7910
- **Practice address phone:** (843) 742-5701
- **Practice address fax:** (843) 742-5704
- **Mailing address:** 100 PRATHER PARK DR, SUITE A, MYRTLE BEACH, SC 29588-7910
- **Mailing address phone:** (843) 742-5701
- **Mailing address fax:** (843) 742-5704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/23/2009
- **Last updated:** 06/24/2009