MEDICARE: MR. CHARLES ESTON HUFF IV P.T.

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	5089	SC

General Provider Information

NPI Number	:	1790811933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES ESTON HUFF IV P.T.

Provider Business Mailing Address
First Line	:	1316 ISLAND CLUB DR UNIT D
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-8251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1316 ISLAND CLUB DR UNIT D
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-8251
Country	:	US
Telephone Number	:	843-830-0490
Fax Number	:

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

Provider Enumeration Date	:	02/24/2007
Last Update Date	:	07/08/2007

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