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General NPI Number Information
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NPI Number | 1609242338
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Entity Type | Individual
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Provider Name | COLLETTE WADE DOE PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 721 WAPPOO RD
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City | CHARLESTON
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State | SC
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Zip | 29407-5861
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Country | US
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Telephone | 843-403-7850
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Fax |
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Provider Business Mailing Address
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Address Line | 195 DROOS WAY
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City | CHARLESTON
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State | SC
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Zip | 29414-6861
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Country | US
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Telephone | 803-230-1402
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7935
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License Number State | SC
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