Healthcare Provider Details

I. General information

NPI: 1639102312
Provider Name (Legal Business Name): LOW COUNTRY PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2586 S HIGHWAY 17 UNIT C&D
MURRELLS INLET SC
29576-6605
US

IV. Provider business mailing address

2586 HIGHWAY 17 SOUTH UNIT C&D
GARDEN CITY BEACH SC
29576-6605
US

V. Phone/Fax

Practice location:
  • Phone: 843-651-6565
  • Fax: 843-651-6575
Mailing address:
  • Phone: 843-651-6565
  • Fax: 843-651-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierGP4329
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: DEBBIE SHOUP
Title or Position: INSURANCE SPECIALIST/CREDENTIALING
Credential:
Phone: 843-651-6565