MEDICARE: JARED LETHCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	7380	SC

General Provider Information

NPI Number	:	1033521596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED LETHCO

Provider Business Mailing Address
First Line	:	2695 ELMS PLANTATION BLVD
Second Line	:	STE. C
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-7132
Country	:	US
Telephone Number	:	843-974-4097
Fax Number	:	843-974-4125

Provider Business Practice Location Address
First Line	:	2695 ELMS PLANTATION BLVD
Second Line	:	STE. C
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-7132
Country	:	US
Telephone Number	:	843-974-4097
Fax Number	:	843-974-4125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	06/02/2014

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Practice Fax:

Directions to “ JARED LETHCO ” Practice Location

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