Healthcare Provider Details

I. General information

NPI: 1841100724
Provider Name (Legal Business Name): COURTNEY BROWN HATHAWAY DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10071 BROAD RIVER RD STE B
IRMO SC
29063-2381
US

IV. Provider business mailing address

141 ATRIUM WAY
COLUMBIA SC
29223-6301
US

V. Phone/Fax

Practice location:
  • Phone: 803-445-1069
  • Fax: 803-445-1097
Mailing address:
  • Phone: 803-445-1069
  • Fax: 803-445-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11792
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: