Healthcare Provider Details

I. General information

NPI: 1780146092
Provider Name (Legal Business Name): EMILY LOUISE BUCHHOLZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY LOUISE WEIDNER DPT

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 NORTHBROOK BLVD STE A9
NORTH CHARLESTON SC
29406-9253
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 843-824-2183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9157
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: