Organization
SOUTHERN STATES PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN CHRISTOPHER FAKER MSPT (OWNER/PHYSICAL THERAPIST)
(704) 578-0641
Entity
Organization
Contact information
Practice address
106A WOODLAND DR, LANCASTER, SC 29720-4707
(803) 283-8442
(803) 286-4604
Mailing address
2670 MILLS PARK DR, ROCK HILL, SC 29732-8599
(803) 324-3745
(803) 324-9845
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4533
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13501810
CAQH
SC
Enumeration date
02/03/2015
Last updated
08/24/2015
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