Organization
IN HOME REHAB OF SOUTH CAROLINA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG PETERS (OWNER)
(803) 407-3869
Entity
Organization
Contact information
Practice address
47 HAVEN RIDGE CT, COLUMBIA, SC 29212-2881
(803) 407-3869
Mailing address
47 HAVEN RIDGE CT, COLUMBIA, SC 29212-2881
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4267
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
250518500
BLUE CROSS BLUE SHIELD
SC
Enumeration date
07/30/2006
Last updated
05/26/2015
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