Healthcare Provider Details

I. General information

NPI: 1326467176
Provider Name (Legal Business Name): IMAGINE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 WESLEY DR SUITE 110
CHARLESTON SC
29407-7204
US

IV. Provider business mailing address

3301 STOCKDALE ST SUITE B
MOUNT PLEASANT SC
29466-7125
US

V. Phone/Fax

Practice location:
  • Phone: 843-554-2323
  • Fax: 843-763-8124
Mailing address:
  • Phone: 843-375-5448
  • Fax: 843-628-6624

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: MR. JOHN A MART
Title or Position: OWNER
Credential: PT
Phone: 843-375-5448