Healthcare Provider Details

I. General information

NPI: 1720644784
Provider Name (Legal Business Name): JEFFREY IRWIN MS, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 TIDAL VIEW LN
CHARLESTON SC
29412-8420
US

IV. Provider business mailing address

1140 TIDAL VIEW LN
CHARLESTON SC
29412-8420
US

V. Phone/Fax

Practice location:
  • Phone: 843-810-5049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number7248085872
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: