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General NPI Number Information
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NPI Number | 1447428982
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Entity Type | Organization
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Legal Business Name | NORTHBRIDGE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 1350 ASHLEY RIVER RD SUITE B
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City | CHARLESTON
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State | SC
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Zip | 29407-5373
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Country | US
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Telephone | 843-571-0877
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Fax | 843-571-0844
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Provider Business Mailing Address
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Address Line | PO BOX 31833
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City | CHARLESTON
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State | SC
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Zip | 29417-1833
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Country | US
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Telephone | 843-571-0877
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Fax | 843-571-0844
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Authorized Official
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Title or Position | OWNER NORTHBRIDGE PT
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Name | MS. SUSAN RAGSDALE KING
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Credential | PHYSICAL THERAPISTPT
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Telephone | 843-343-5108
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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 | 1319
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License Number State | SC
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