Healthcare Provider Details

I. General information

NPI: 1497310643
Provider Name (Legal Business Name): BRIGHT ALLIANCE REHABILITATION MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9181 MEDCOM ST
NORTH CHARLESTON SC
29406-9168
US

IV. Provider business mailing address

6650 RIVERS AVE STE 105
NORTH CHARLESTON SC
29406-4829
US

V. Phone/Fax

Practice location:
  • Phone: 843-820-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: ELISE SALERNO
Title or Position: OWNER
Credential: MD
Phone: 843-820-7777