Healthcare Provider Details

I. General information

NPI: 1245241041
Provider Name (Legal Business Name): IMAGINE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 LANDAU LANE
MT PLEASANT SC
29466-7300
US

IV. Provider business mailing address

IMAGINE PHYSICAL THERAPY 5111 NORTH RHETT AVENUE
NORTH CHARLESTON SC
29405-4219
US

V. Phone/Fax

Practice location:
  • Phone: 843-375-5448
  • Fax: 843-628-6624
Mailing address:
  • Phone: 843-804-9033
  • Fax: 843-804-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN MART
Title or Position: OWNER
Credential:
Phone: 843-375-5448