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General NPI Number Information
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NPI Number | 1407825706
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Entity Type | Organization
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Legal Business Name | DENISE B. FREDERICKS, PT, LLC
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1636 OAK ISLAND DR
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City | CHARLESTON
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State | SC
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Zip | 29412-9519
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Country | US
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Telephone | 843-762-6793
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Fax | 843-762-1154
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Provider Business Mailing Address
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Address Line | 1636 OAK ISLAND DR
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City | CHARLESTON
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State | SC
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Zip | 29412-9519
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Country | US
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Telephone | 843-762-6793
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Fax | 843-762-1154
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. DENISE BUNDRICK FREDERICKS
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Credential | PT
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Telephone | 843-906-5210
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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 | 1623
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License Number State | SC
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