MEDICARE: LAURA O'BRIEN FROMDAHL MSPT

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	4140	SC

General Provider Information

NPI Number	:	1760640981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA O'BRIEN FROMDAHL MSPT

Provider Business Mailing Address
First Line	:	11 EWALL ST STE 159
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3062
Country	:	US
Telephone Number	:	843-972-7199
Fax Number	:	843-203-0049

Provider Business Practice Location Address
First Line	:	11 EWALL ST STE 159
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3062
Country	:	US
Telephone Number	:	843-972-7199
Fax Number	:	843-203-0049

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

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	04/15/2026

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