Healthcare Provider Details

I. General information

NPI: 1811738248
Provider Name (Legal Business Name): EMILY GONNERMAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 LEEDS PL W
NORTH CHARLESTON SC
29405-8402
US

IV. Provider business mailing address

4480 LEEDS PL W
NORTH CHARLESTON SC
29405-8402
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-2885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12369
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: