Healthcare Provider Details

I. General information

NPI: 1548182876
Provider Name (Legal Business Name): GRIST MILL PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 N PARIS AVE
PORT ROYAL SC
29935-2029
US

IV. Provider business mailing address

4461 SPRING IS
OKATIE SC
29909-4756
US

V. Phone/Fax

Practice location:
  • Phone: 224-944-1257
  • Fax:
Mailing address:
  • Phone: 224-944-1257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHEN MANKER
Title or Position: OWNER
Credential:
Phone: 224-944-1257