Healthcare Provider Details

I. General information

NPI: 1053010298
Provider Name (Legal Business Name): OLYMPIA INNOVATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
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: 843-969-1000
  • Fax:
Mailing address:
  • Phone: 843-969-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIRIAM DEHART
Title or Position: PRESIDENT
Credential: MPT
Phone: 484-951-7268