Healthcare Provider Details

I. General information

NPI: 1215941513
Provider Name (Legal Business Name): PERSONAL CARE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 ARROWHEAD HALL
JOHNS ISLAND SC
29455
US

IV. Provider business mailing address

19 ARROWHEAD HALL PERSONAL CARE PHYSICAL THERAPY
JOHNS ISLAND SC
29455
US

V. Phone/Fax

Practice location:
  • Phone: 843-327-6278
  • Fax:
Mailing address:
  • Phone: 843-327-6278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3301
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3301
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3301
License Number StateSC

VIII. Authorized Official

Name: MR. GERARD JOSEPH SCIBILIA
Title or Position: OWNER THERAPIST
Credential: DPT
Phone: 843-327-6278