Healthcare Provider Details

I. General information

NPI: 1184356578
Provider Name (Legal Business Name): CLAIRE BEAUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 REDHAWK WAY STE 110
BLYTHEWOOD SC
29016-9286
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-314-5600
  • Fax: 803-314-5601
Mailing address:
  • Phone: 803-791-2491
  • Fax: 803-794-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11620
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: