Healthcare Provider Details

I. General information

NPI: 1942599089
Provider Name (Legal Business Name): CAPITAL CITY THERAPY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OLD CHEROKEE RD SUITE F, BOX 172
LEXINGTON SC
29072-9316
US

IV. Provider business mailing address

100 OLD CHEROKEE RD SUITE F, BOX 172
LEXINGTON SC
29072-9316
US

V. Phone/Fax

Practice location:
  • Phone: 803-467-8596
  • Fax: 803-356-0468
Mailing address:
  • Phone: 803-467-8596
  • Fax: 803-356-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2606
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3537
License Number StateSC

VIII. Authorized Official

Name: MRS. CHRISTINE SPEEGLE
Title or Position: OWNER
Credential: OT
Phone: 803804791758