Healthcare Provider Details

I. General information

NPI: 1649254319
Provider Name (Legal Business Name): CAROLINA THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 JADE CIR
ORANGEBURG SC
29115-8166
US

IV. Provider business mailing address

107 JADE CIR
ORANGEBURG SC
29115-8166
US

V. Phone/Fax

Practice location:
  • Phone: 803-533-8092
  • Fax: 803-268-9603
Mailing address:
  • Phone: 803-533-8092
  • Fax: 803-268-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2674
License Number StateSC

VIII. Authorized Official

Name: MR. HENRY FRANKLIN GRAHAM JR.
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 803-533-8092