Healthcare Provider Details

I. General information

NPI: 1174634380
Provider Name (Legal Business Name): PLAYTIME PEDIATRIC PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CAINHOY LANDING RD
WANDO SC
29492-7801
US

IV. Provider business mailing address

116 CAINHOY LANDING RD
WANDO SC
29492-7801
US

V. Phone/Fax

Practice location:
  • Phone: 843-442-7232
  • Fax:
Mailing address:
  • Phone:
  • 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: JENNIFER BALDWIN
Title or Position: PHYSICAL THERAPIST, SOLE PROPRIETOR
Credential: RPT
Phone: 843-442-7232