Organization
MAGNOLIA MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR M CORTINA PT (CFO)
(864) 621-5646
Entity
Organization
Contact information
Practice address
800 PELHAM RD, THIRD FLOOR - PHYSICAL THERAPY DEPARTMENT, GREENVILLE, SC 29615-3300
(864) 752-3357
(678) 840-2112
Mailing address
PO BOX 25306, GREENVILLE, SC 29616-0306
(864) 752-3357
(678) 840-2112
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
SC
225X00000X
Occupational Therapist
—
SC
235Z00000X
Speech-Language Pathologist
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3940
—
SC
Enumeration date
12/11/2005
Last updated
04/18/2012
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