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General NPI Number Information
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NPI Number | 1003295908
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Entity Type | Organization
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Legal Business Name | LOWCOUNTRY PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 3019 SAINTSBURY COVE DR
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City | CHARLESTON
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State | SC
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Zip | 29414-8001
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Country | US
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Telephone | 704-301-4733
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Fax |
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Provider Business Mailing Address
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Address Line | 3019 SAINTSBURY COVE DR
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City | CHARLESTON
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State | SC
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Zip | 29414-8001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JACQUELINE WILKINSON
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Credential |
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Telephone | 704-301-4733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 6203
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License Number State | SC
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