# IN HOME REHAB OF SOUTH CAROLINA LLC

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

## Provider details

- **NPI number:** 1669487476
- **Authorized official:** CRAIG PETERS (OWNER)
- **Authorized official phone:** (803) 407-3869

## Contact information

- **Practice address:** 47 HAVEN RIDGE CT, COLUMBIA, SC 29212-2881
- **Practice address phone:** (803) 407-3869
- **Mailing address:** 47 HAVEN RIDGE CT, COLUMBIA, SC 29212-2881

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 4267 | SC | Yes |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 05/26/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 250518500 | BLUE CROSS BLUE SHIELD | SC |