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General NPI Number Information
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NPI Number | 1306890579
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1319 SAVANNAH HWY SUITE D
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City | CHARLESTON
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State | SC
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Zip | 29407-7848
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Country | US
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Telephone | 843-769-7773
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Fax | 843-329-4043
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Provider Business Mailing Address
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Address Line | 1319 SAVANNAH HWY SUITE D
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City | CHARLESTON
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State | SC
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Zip | 29407-7848
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Country | US
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Telephone | 843-769-7773
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Fax | 843-329-4043
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARSHA COTTER CALLAHAN
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Credential | PT
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Telephone | 843-769-7773
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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 | 505
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License Number State | SC
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