Healthcare Provider Details

I. General information

NPI: 1265881544
Provider Name (Legal Business Name): CAITLAN M SCHANNE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 NORTHBROOK BLVD STE A-9
NORTH CHARLESTON SC
29406-9252
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 843-824-2183
  • Fax: 843-553-3221
Mailing address:
  • Phone: 630-296-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8190
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: