# OMNI PHYSICAL THERAPY INC

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

## Provider details

- **NPI number:** 1316097702
- **Authorized official:** MRS. MELISSA KEZIAH SHUMATE MPT (PHYSICAL THERAPIST)
- **Authorized official phone:** (843) 409-1620

## Contact information

- **Practice address:** 126 N MACARTHUR AVE, DILLON, SC 29536-3434
- **Practice address phone:** (843) 774-7462
- **Practice address fax:** (843) 841-2482
- **Mailing address:** 1647 RUBY RD, HARTSVILLE, SC 29550-2407
- **Mailing address phone:** (843) 409-1620

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 4705 | SC | Yes |

## Other

- **Enumeration date:** 01/10/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | TH1381 | — | SC |