Healthcare Provider Details

I. General information

NPI: 1073102315
Provider Name (Legal Business Name): BREAK FREE WITH PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 HOLLYDALE CT UNIT C
JOHNS ISLAND SC
29455-8319
US

IV. Provider business mailing address

1944 EVERETT ST
JOHNS ISLAND SC
29455-8117
US

V. Phone/Fax

Practice location:
  • Phone: 843-478-9778
  • Fax:
Mailing address:
  • Phone: 843-478-9778
  • Fax:

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: DR. GRETCHEN RAE BROOKER
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 843-478-9778