Healthcare Provider Details

I. General information

NPI: 1396455515
Provider Name (Legal Business Name): CENTRUM THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 09/02/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MALLORY DR
GOOSE CREEK SC
29445-6406
US

IV. Provider business mailing address

PO BOX 1119
GOOSE CREEK SC
29445-1119
US

V. Phone/Fax

Practice location:
  • Phone: 843-996-1471
  • Fax: 843-808-6986
Mailing address:
  • Phone: 843-996-1471
  • Fax: 843-808-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: NATHAN PRATER
Title or Position: OWNER
Credential: PT
Phone: 864-993-6304