Healthcare Provider Details

I. General information

NPI: 1972480630
Provider Name (Legal Business Name): HEALING BEACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2025
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603B BRIARWOOD DR
MYRTLE BEACH SC
29572-5745
US

IV. Provider business mailing address

679 RIVERWALK DR UNIT 201
MYRTLE BEACH SC
29579-7550
US

V. Phone/Fax

Practice location:
  • Phone: 843-564-3339
  • Fax: 843-567-1033
Mailing address:
  • Phone: 843-564-3339
  • Fax: 843-567-1033

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

VIII. Authorized Official

Name: ELLEN TODD
Title or Position: OWNER / PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 843-450-9177