Healthcare Provider Details

I. General information

NPI: 1437037108
Provider Name (Legal Business Name): JALEN PRATT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 PARKLANE RD
COLUMBIA SC
29223-6122
US

IV. Provider business mailing address

7601 PARKLANE RD
COLUMBIA SC
29223-6122
US

V. Phone/Fax

Practice location:
  • Phone: 803-741-9090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4576
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: