MEDICARE: CHARLES MARTIN CROUCH III

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	PT13212	SC

General Provider Information

NPI Number	:	1114879343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES MARTIN CROUCH III

Provider Business Mailing Address
First Line	:	405 FAISON RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-9526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 FAISON RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-9526
Country	:	US
Telephone Number	:	843-352-2935
Fax Number	:

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

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “ CHARLES MARTIN CROUCH III ” Practice Location

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