MEDICARE: HEALING BEACH 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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1972480630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING BEACH LLC

Provider Business Mailing Address
First Line	:	679 RIVERWALK DR UNIT 201
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7550
Country	:	US
Telephone Number	:	843-564-3339
Fax Number	:	843-567-1033

Provider Business Practice Location Address
First Line	:	603B BRIARWOOD DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-5745
Country	:	US
Telephone Number	:	843-564-3339
Fax Number	:	843-567-1033

Authorized Official
Title or Position	:	OWNER / PHYSICAL THERAPIST
Name	:	ELLEN TODD
Credential	:	PT, DPT
Telephone Number	:	843-450-9177

Provider Enumeration Date	:	08/16/2025
Last Update Date	:	05/12/2026

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