Organization
ABL WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMAYA BRIONNA LILES PT,DPT (OWNER)
(803) 859-5063
Entity
Organization
Contact information
Practice address
1730 CARL RD, COLUMBIA, SC 29210-7707
(856) 265-4739
Mailing address
6650 RIVERS AVE STE 105, NORTH CHARLESTON, SC 29406-4829
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11841
BOARD OF PHYSICAL THERAPY EXAMINERS
SC
Enumeration date
07/24/2024
Last updated
07/24/2024
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