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General NPI Number Information
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NPI Number | 1356544415
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Entity Type | Organization
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Legal Business Name | GRACE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 440 UNIT D OLD TROLLEY ROAD
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City | SUMMERVILLE
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State | SC
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Zip | 29485
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Country | US
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Telephone | 843-871-3522
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Fax | 843-871-3523
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Provider Business Mailing Address
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Address Line | 440 UNIT D OLD TROLLEY ROAD
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City | SUMMERVILLE
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State | SC
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Zip | 29485
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Country | US
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Telephone | 843-871-3522
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Fax | 843-871-3523
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | ALICIA DUNCAN
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Credential |
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Telephone | 843-871-3522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3858
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License Number State | SC
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