Healthcare Provider Details

I. General information

NPI: 1932276805
Provider Name (Legal Business Name): CHARLESTON PEDIATRIC REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 ASHLEY RIVER RD
CHARLESTON SC
29407-5305
US

IV. Provider business mailing address

1407 ASHLEY RIVER RD
CHARLESTON SC
29407-5305
US

V. Phone/Fax

Practice location:
  • Phone: 843-769-0663
  • Fax: 843-769-0556
Mailing address:
  • Phone: 843-769-0663
  • Fax: 843-769-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL COYLE
Title or Position: OWNER
Credential: OTRL
Phone: 843-769-0663