Healthcare Provider Details

I. General information

NPI: 1013496645
Provider Name (Legal Business Name): MEGAN ELAINE CASTLES PT, DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN JOHNSON

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
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: 843-314-5434
  • Fax:
Mailing address:
  • Phone: 843-314-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000022563
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9260
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: