Organization
GYROTONIC VISTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES C PULLIAM (MANAGER)
(803) 758-5962
Entity
Organization
Contact information
Practice address
911 LADY ST, SUITE H, COLUMBIA, SC 29201-3105
(803) 758-5962
Mailing address
911 LADY ST, SUITE H, COLUMBIA, SC 29201-3105
(803) 758-5962
Taxonomy
Speciality
Code
Description
License number
State
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
Primary
0724727
SC
2255A2300X
Athletic Trainer
0724727
SC
225600000X
Dance Therapist
0724727
SC
225700000X
Massage Therapist
0724727
SC
Other
Enumeration date
03/30/2011
Last updated
03/30/2011
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