Healthcare Provider Details

I. General information

NPI: 1033494877
Provider Name (Legal Business Name): HEATHER JACKSON THOMPSON PT, DPT, GCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER JACKSON

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SEACOAST PKWY UNIT D
MOUNT PLEASANT SC
29464-8263
US

IV. Provider business mailing address

401 SEACOAST PKWY UNIT D
MOUNT PLEASANT SC
29464-8263
US

V. Phone/Fax

Practice location:
  • Phone: 843-969-2201
  • Fax: 843-969-2202
Mailing address:
  • Phone: 843-969-2201
  • Fax: 843-969-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4928
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: