Provider Demographics
NPI:1538198379
Name:ALCANTARA, FELIX V
Entity type:Individual
Prefix:
First Name:FELIX
Middle Name:V
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1864
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29602-1864
Mailing Address - Country:US
Mailing Address - Phone:843-320-8000
Mailing Address - Fax:843-320-8002
Practice Address - Street 1:2307 E HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-6351
Practice Address - Country:US
Practice Address - Phone:843-320-8000
Practice Address - Fax:843-320-8002
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q34200Medicare UPIN
SC8610Medicare PIN