Healthcare Provider Details

I. General information

NPI: 1033518766
Provider Name (Legal Business Name): IMAGINE PHYSICAL THERAPY NORTH RHETT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 N RHETT AVE
NORTH CHARLESTON SC
29405-4219
US

IV. Provider business mailing address

5111 N RHETT AVE
NORTH CHARLESTON SC
29405-4219
US

V. Phone/Fax

Practice location:
  • Phone: 843-375-5448
  • Fax: 843-628-6624
Mailing address:
  • Phone: 843-804-9077
  • Fax: 843-628-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number7041
License Number StateSC

VIII. Authorized Official

Name: BETH WILLIAMSON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 843-804-9479