Healthcare Provider Details

I. General information

NPI: 1033181110
Provider Name (Legal Business Name): PREMIER PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 NORTHBROOK BLVD. SUITE B6
NORTH CHARLESTON SC
29406-9252
US

IV. Provider business mailing address

2070 NORTHBROOK BLVD. SUITE B6
NORTH CHARLESTON SC
29406-9252
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-5167
  • Fax: 843-797-5723
Mailing address:
  • Phone: 843-797-5167
  • Fax: 843-797-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateSC

VIII. Authorized Official

Name: JILL M. BOORMAN
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: BS PT
Phone: 843-797-5167