Individual
PHILLIP BRENT REUSTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
225 E WOOD ST, SPARTANBURG, SC 29303-3050
(864) 560-4420
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3367
SC
363AS0400X
Surgical Physician Assistant
Primary
3367
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3359PA
—
SC
01
—
SCG4005019
MEDICARE PIN
SC
Enumeration date
09/15/2007
Last updated
04/18/2024
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