Healthcare Provider Details

I. General information

NPI: 1427093749
Provider Name (Legal Business Name): CHARLESTON CHILDREN'S THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 UNIVERSITY BLVD STE. E2C
NORTH CHARLESTON SC
29406-9149
US

IV. Provider business mailing address

9225 UNIVERSITY BLVD STE. E2C
NORTH CHARLESTON SC
29406-9149
US

V. Phone/Fax

Practice location:
  • Phone: 843-569-4546
  • Fax: 843-569-4535
Mailing address:
  • Phone: 843-569-4546
  • Fax: 843-569-4535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. CHARLENE DURHAM
Title or Position: CO-OWNER/MANAGER
Credential: MSR, PT
Phone: 843-569-4546