Healthcare Provider Details

I. General information

NPI: 1326577214
Provider Name (Legal Business Name): LEROY TART JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 N HIGHWAY 501
MARION SC
29571-6122
US

IV. Provider business mailing address

6500 N HIGHWAY 501
MARION SC
29571-6122
US

V. Phone/Fax

Practice location:
  • Phone: 843-245-3553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: