Healthcare Provider Details

I. General information

NPI: 1316473879
Provider Name (Legal Business Name): LCR THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9275 MEDICAL PLAZA DR
NORTH CHARLESTON SC
29406-9140
US

IV. Provider business mailing address

9267 MEDICAL PLAZA DR
NORTH CHARLESTON SC
29406-9139
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-3636
  • Fax:
Mailing address:
  • Phone: 843-797-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: GOKUL GONDI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 843-797-3636