Healthcare Provider Details

I. General information

NPI: 1942546429
Provider Name (Legal Business Name): AZALEA PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240B CENTRAL AVE
SUMMERVILLE SC
29483-3148
US

IV. Provider business mailing address

1240B CENTRAL AVE
SUMMERVILLE SC
29483-3148
US

V. Phone/Fax

Practice location:
  • Phone: 843-261-1199
  • Fax: 843-821-8799
Mailing address:
  • Phone: 843-261-1199
  • Fax: 843-821-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. HOKE STEWART II
Title or Position: PRESIDENT
Credential:
Phone: 843-261-1199