MEDICARE: FORGE HEALTH, LLC

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	8111	SC
2	225100000X	Physical Therapist	014488	OH
3	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1265930234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORGE HEALTH, LLC

Provider Business Mailing Address
First Line	:	3691 SPINDRIFT DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-7552
Country	:	US
Telephone Number	:	513-461-1069
Fax Number	:

Provider Business Practice Location Address
First Line	:	3691 SPINDRIFT DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-7552
Country	:	US
Telephone Number	:	513-461-1069
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. CHRISTOPHER SCOTT WILSON
Credential	:	DPT
Telephone Number	:	513-461-1069

Provider Enumeration Date	:	01/24/2018
Last Update Date	:	01/24/2018

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Directions to “FORGE HEALTH, LLC ” Practice Location

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