Healthcare Provider Details

I. General information

NPI: 1700150570
Provider Name (Legal Business Name): THERAPYWORKS 4 KIDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2012
Last Update Date: 02/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 FORT MILL HWY STE A
INDIAN LAND SC
29707-7698
US

IV. Provider business mailing address

1162 FORT MILL HWY STE A
INDIAN LAND SC
29707-7698
US

V. Phone/Fax

Practice location:
  • Phone: 803-548-9113
  • Fax: 803-548-9116
Mailing address:
  • Phone: 803-548-9113
  • Fax: 803-548-9116

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
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CORRIE LONG
Title or Position: OWNER
Credential: PT
Phone: 803-548-9113