Healthcare Provider Details

I. General information

NPI: 1427575091
Provider Name (Legal Business Name): ADVANTAGE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 LONG POINT RD STE 106
MOUNT PLEASANT SC
29464-8279
US

IV. Provider business mailing address

537 LONG POINT RD STE 106
MOUNT PLEASANT SC
29464-8279
US

V. Phone/Fax

Practice location:
  • Phone: 843-718-2683
  • Fax: 803-573-1050
Mailing address:
  • Phone: 843-718-2683
  • Fax: 843-388-7149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN CANCIENNE
Title or Position: OWNER
Credential:
Phone: 843-718-2683