Healthcare Provider Details

I. General information

NPI: 1831957745
Provider Name (Legal Business Name): FULL LIFE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 TOOLE CIR
BEECH ISLAND SC
29842
US

IV. Provider business mailing address

241 TOOLE CIR
BEECH ISLAND SC
29842
US

V. Phone/Fax

Practice location:
  • Phone: 828-734-3469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. LOGAN LEE
Title or Position: PHYSICAL THERAPIST / OWNER
Credential: PT, DPT
Phone: 828-734-3469