Healthcare Provider Details

I. General information

NPI: 1699604355
Provider Name (Legal Business Name): MARY MCCULLOUGH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 BOUNDARY ST STE 200
BEAUFORT SC
29902-6812
US

IV. Provider business mailing address

2121 BOUNDARY ST STE 200
BEAUFORT SC
29902-6812
US

V. Phone/Fax

Practice location:
  • Phone: 843-524-4778
  • Fax: 843-524-4779
Mailing address:
  • Phone: 843-524-4778
  • Fax: 843-524-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13351
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: