Healthcare Provider Details

I. General information

NPI: 1407974405
Provider Name (Legal Business Name): SHELLEY BIRNIE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 WANDO PARK BLVD STE 200
MT PLEASANT SC
29464-7902
US

IV. Provider business mailing address

498 WANDO PARK BLVD STE 200
MT PLEASANT SC
29464-7902
US

V. Phone/Fax

Practice location:
  • Phone: 843-884-1118
  • Fax: 843-448-2434
Mailing address:
  • Phone: 843-884-1118
  • Fax: 843-448-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1042
License Number StateSC

VIII. Authorized Official

Name: MS. SHELLEY BIRNIE
Title or Position: MANAGING MEMBER
Credential: PT
Phone: 843-884-1118