Healthcare Provider Details

I. General information

NPI: 1154472975
Provider Name (Legal Business Name): PREMIER PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 YEAMANS HALL RD STE 4
HANAHAN SC
29410-2790
US

IV. Provider business mailing address

1238 YEAMANS HALL RD STE 4
HANAHAN SC
29410-2790
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-5167
  • Fax: 843-797-5723
Mailing address:
  • Phone: 843-797-5167
  • Fax: 843-797-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5201
License Number StateSC

VIII. Authorized Official

Name: MS. JILL MARIE BOORMAN
Title or Position: OWNER
Credential: BS PT
Phone: 843-797-5167