Organization
SPROUT PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RHYNO COETSEE PT (ADMINISTRATOR)
(803) 361-6995
Entity
Organization
Contact information
Practice address
108 BELFAIR RD, IRMO, SC 29063-8040
(803) 361-6995
Mailing address
108 BELFAIR RD, IRMO, SC 29063-8040
(803) 361-6995
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2940
SC
Other
Enumeration date
04/09/2012
Last updated
04/09/2012
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