# CORA SOUTH CAROLINA LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** CORA Physical Therapy - Carnes Crossroads
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366008955
- **Authorized official:** BRAD C. ROUSH (EXECUTIVE VICE PRESIDENT)
- **Authorized official phone:** (419) 221-6712

## Contact information

- **Practice address:** 515 CARNES CROSSING BLVD STE B, SUMMERVILLE, SC 29486-0412
- **Practice address phone:** (419) 221-6717
- **Practice address fax:** (419) 222-0507
- **Mailing address:** 1110 SHAWNEE RD, LIMA, OH 45805-3529
- **Mailing address phone:** (419) 221-6717
- **Mailing address fax:** (419) 222-0507

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/20/2019
- **Last updated:** 10/18/2019