# GROUPHAB

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

## Provider details

- **NPI number:** 1912300971
- **Authorized official:** PATRICE RENEE HAZAN (OWNER, FOUNDER, PHYSICAL THERAPIST)
- **Authorized official phone:** (864) 525-2654

## Contact information

- **Practice address:** 30 HOWARD CREEK DR, FOUNTAIN INN, SC 29644-1318
- **Practice address phone:** (864) 525-2654
- **Mailing address:** 205 SHADOWBROOKE CT, SIMPSONVILLE, SC 29681-5184
- **Mailing address phone:** (864) 525-2654

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 3027 | SC | Yes |

## Other

- **Enumeration date:** 10/06/2014
- **Last updated:** 10/06/2014