Healthcare Provider Details

I. General information

NPI: 1447591607
Provider Name (Legal Business Name): TRI-COUNTY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 COMMERCIAL CENTER DR
LADSON SC
29456-4146
US

IV. Provider business mailing address

3851 COMMERCIAL CENTER DR
LADSON SC
29456-4146
US

V. Phone/Fax

Practice location:
  • Phone: 888-510-9156
  • Fax: 888-510-5362
Mailing address:
  • Phone: 888-510-9156
  • Fax: 888-510-9156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3969
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4299
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4522
License Number StateSC

VIII. Authorized Official

Name: ALLISON LYNNE KANE
Title or Position: OWNER/PROVIDER
Credential:
Phone: 888-510-6369