Healthcare Provider Details

I. General information

NPI: 1740627066
Provider Name (Legal Business Name): CAROLINA REHAB AND PHYSICAL MEDICINE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 HIGHWAY 17
LITTLE RIVER SC
29566-9224
US

IV. Provider business mailing address

1539 HIGHWAY 17
LITTLE RIVER SC
29566-9224
US

V. Phone/Fax

Practice location:
  • Phone: 843-249-9787
  • Fax: 843-249-9655
Mailing address:
  • Phone: 843-249-9787
  • Fax: 843-249-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN STRICKLAND
Title or Position: SOLE MEMBER
Credential:
Phone: 843-249-9787