Organization
VITAL ENERGY OCCUPATIONAL THERAPY & WELLNESS CTR
Active
Parent organization
VITAL ENERGY OCCUPATIONAL THERAPY AND WELLNESS CTR
Other names
VITAL ENERGY PHYSICAL THERAPY
Organization subpart
Yes
Provider details
NPI number
Legal business name
VITAL ENERGY OCCUPATIONAL THERAPY AND WELLNESS CTR
Authorized official
SUZY SHAY (OFFICE MGR)
(803) 359-1551
Entity
Organization
Contact information
Practice address
4114 FOREST DR, COLUMBIA, SC 29204-4316
(803) 359-1551
Mailing address
121 CLEARVIEW DR, COLUMBIA, SC 29212-8304
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9433
MEDICARE PTAN
SC
Enumeration date
02/11/2013
Last updated
02/11/2013
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