Organization
VITAL ENERGY REHAB NC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HIMA N DALAL OT (OWENER)
(803) 359-1551
Entity
Organization
Contact information
Practice address
9007 MAGNA LN, INDIAN TRAIL, NC 28079-5216
(704) 698-2104
Mailing address
121 CLEARVIEW DR, COLUMBIA, SC 29212-8304
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
05/06/2011
Last updated
05/06/2011
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