Healthcare Provider Details

I. General information

NPI: 1962334185
Provider Name (Legal Business Name): PRESTON ROBERT SLATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 BANKTON CIR
HANAHAN SC
29410-2957
US

IV. Provider business mailing address

627 BATTERY PARK CIR # 627
ANDERSON SC
29621-2800
US

V. Phone/Fax

Practice location:
  • Phone: 877-407-3422
  • Fax:
Mailing address:
  • Phone: 864-245-4307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13384
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: