Healthcare Provider Details

I. General information

NPI: 1780574459
Provider Name (Legal Business Name): L2 ATHLETIC DEVELOPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2025
Last Update Date: 07/05/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 PUBLIC SQ UNIT 282
DARLINGTON SC
29532-3220
US

IV. Provider business mailing address

6500 N HIGHWAY 501
MARION SC
29571-6122
US

V. Phone/Fax

Practice location:
  • Phone: 843-245-3553
  • Fax:
Mailing address:
  • Phone: 843-245-3553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. LEROY TART JR.
Title or Position: OWNER / THERAPIST
Credential: PTA / LMT
Phone: 843-245-3553