Healthcare Provider Details

I. General information

NPI: 1588977862
Provider Name (Legal Business Name): IMAGINE PHYSICAL THERAPY IN WEST ASHLEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2267 ASHLEY RIVER ROAD
CHARLESTON SC
29414-4736
US

IV. Provider business mailing address

5111 NORTH RHETT AVENUE IMAGINE PHYSICAL THERAPY
NORTH CHARLESTON SC
29405-4219
US

V. Phone/Fax

Practice location:
  • Phone: 843-576-4121
  • Fax: 843-793-3575
Mailing address:
  • Phone: 843-804-9077
  • Fax: 843-804-9020

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: BETH WILLIAMSON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 843-804-9479