Healthcare Provider Details

I. General information

NPI: 1962687467
Provider Name (Legal Business Name): LIFESTYLE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 09/06/2023
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4543 CHARLOTTE HWY SUITE 11
CLOVER SC
29710-7073
US

IV. Provider business mailing address

4543 CHARLOTTE HWY SUITE 11
CLOVER SC
29710-7073
US

V. Phone/Fax

Practice location:
  • Phone: 803-831-1454
  • Fax: 803-831-1455
Mailing address:
  • Phone: 803-831-1454
  • Fax: 803-831-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5214
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KAREN S SHULER
Title or Position: OWNER
Credential: PT, DPT
Phone: 704-798-2735