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Organization
BEHAVIORS A GO-GO
Active
Organization
BEHAVIORS A GO-GO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZA KATHLEEN MCCORMICK (BILLING & CREDENTIAING MANAGER)
(864) 920-2527
Entity
Organization
Contact information
Practice address
511 W BUTLER RD, GREENVILLE, SC 29607-4890
(864) 757-9918
(864) 757-9921
Mailing address
219 GERALD DR, SIMPSONVILLE, SC 29681-4111
(864) 757-9918
(864) 757-9921
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
NULL
2251P0200X
Pediatric Physical Therapist
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
06/28/2019
Last updated
06/28/2019
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