Healthcare Provider Details

I. General information

NPI: 1871240671
Provider Name (Legal Business Name): NICOLE L O'DOHERTY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 PROFESSIONAL LN
PAWLEYS ISLAND SC
29585-8631
US

IV. Provider business mailing address

355 SHORE RUSH DR
PAWLEYS ISLAND SC
29585-6481
US

V. Phone/Fax

Practice location:
  • Phone: 843-585-3303
  • Fax:
Mailing address:
  • Phone: 843-585-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11237
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: