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General NPI Number Information
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NPI Number | 1518266543
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Entity Type | Organization
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Legal Business Name | CORBETT PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 25 PEARCE RD
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City | BLUFFTON
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State | SC
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Zip | 29910-9353
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Country | US
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Telephone | 843-837-1930
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Fax | 843-837-1931
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Provider Business Mailing Address
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Address Line | 25 PEARCE RD
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City | BLUFFTON
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State | SC
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Zip | 29910-9353
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Country | US
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Telephone | 843-837-1930
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Fax | 843-837-1931
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Authorized Official
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Title or Position | OWNER/CEO
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Name | CHARLES DAVID STALLINGS III
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Credential | PT, DPT
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Telephone | 843-837-1930
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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 | 5842
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License Number State | SC
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