Healthcare Provider Details

I. General information

NPI: 1275284739
Provider Name (Legal Business Name): DYNAMIC BEGINNINGS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2022
Last Update Date: 01/15/2022
Certification Date: 01/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DEER RUN RD
ELGIN SC
29045-8605
US

IV. Provider business mailing address

PO BOX 281
BALLENTINE SC
29002-0281
US

V. Phone/Fax

Practice location:
  • Phone: 803-422-3894
  • Fax:
Mailing address:
  • Phone: 803-422-3894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SHAE PEAK
Title or Position: OFFICE MANAGER
Credential:
Phone: 803-422-3894