Healthcare Provider Details

I. General information

NPI: 1356533012
Provider Name (Legal Business Name): JOHN CHADWICK OWNBEY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8545 DORCHESTER RD
N CHARLESTON SC
29420-7308
US

IV. Provider business mailing address

8545 DORCHESTER RD
N CHARLESTON SC
29420-7308
US

V. Phone/Fax

Practice location:
  • Phone: 843-767-3765
  • Fax: 843-767-3785
Mailing address:
  • Phone: 843-767-3765
  • Fax: 843-767-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5561
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8277
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: