Healthcare Provider Details

I. General information

NPI: 1396571543
Provider Name (Legal Business Name): JADYN AUDRIE SLAUGHTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PINCKNEY BLVD
BEAUFORT SC
29902-6122
US

IV. Provider business mailing address

337 SAVANNAH HWY APT 810
BEAUFORT SC
29906-6741
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-5600
  • Fax:
Mailing address:
  • Phone: 864-712-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0020152
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: