Healthcare Provider Details

I. General information

NPI: 1689459323
Provider Name (Legal Business Name): CAROLINA DOCTORS OF PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 RIVERWALK BLVD STE 2F
RIDGELAND SC
29936-5071
US

IV. Provider business mailing address

61 RIVERWALK BLVD STE 2F
RIDGELAND SC
29936-5071
US

V. Phone/Fax

Practice location:
  • Phone: 843-645-6978
  • Fax:
Mailing address:
  • Phone: 843-645-6978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT L.AWRENCE HOLMAN
Title or Position: PRESIDENT/PHYSICAL THERAPIST
Credential: PT DPT OCS
Phone: 951-375-7102