Provider Demographics
NPI:1033424361
Name:GREWAL, ROHINI (DPT)
Entity type:Individual
Prefix:MRS
First Name:ROHINI
Middle Name:
Last Name:GREWAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ROHINI
Other - Middle Name:
Other - Last Name:GUNDARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 WELLNESS BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063
Mailing Address - Country:US
Mailing Address - Phone:803-749-0808
Mailing Address - Fax:803-749-0308
Practice Address - Street 1:1 WELLNESS BLVD.
Practice Address - Street 2:SUITE 204
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063
Practice Address - Country:US
Practice Address - Phone:803-749-0808
Practice Address - Fax:803-749-0308
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871159225100000X
SC6981225100000X, 225200000X
VA2305207609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC426584OtherOTHER, MEDICARE PTAN
DC195925YT9Medicare PIN
SC426584OtherOTHER, MEDICARE PTAN