Healthcare Provider Details

I. General information

NPI: 1003731936
Provider Name (Legal Business Name): ELYSSA BENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 FABER PLACE DR STE 420
NORTH CHARLESTON SC
29405-8594
US

IV. Provider business mailing address

4105 FABER PLACE DR STE 420
NORTH CHARLESTON SC
29405-8594
US

V. Phone/Fax

Practice location:
  • Phone: 843-894-7374
  • Fax:
Mailing address:
  • Phone: 843-894-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number12903
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: