Healthcare Provider Details

I. General information

NPI: 1538615349
Provider Name (Legal Business Name): MIRIAM STEWART DEHART MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 TOWNE DR
BLUFFTON SC
29910-4201
US

IV. Provider business mailing address

69 TOWNE DR
BLUFFTON SC
29910-4201
US

V. Phone/Fax

Practice location:
  • Phone: 484-515-1023
  • Fax: 843-969-2000
Mailing address:
  • Phone: 484-515-1023
  • Fax: 843-969-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11584
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: