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General NPI Number Information
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NPI Number | 1780574459
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Entity Type | Organization
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Legal Business Name | L2 ATHLETIC DEVELOPMENT, LLC
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Dates
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Enumeration Date | 07/05/2025
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Last Update Date | 07/05/2025
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Provider Practice Location Address
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Address Line | 44 PUBLIC SQ UNIT 282
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City | DARLINGTON
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State | SC
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Zip | 29532-3220
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Country | US
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Telephone | 843-245-3553
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Fax |
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Provider Business Mailing Address
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Address Line | 6500 N HIGHWAY 501
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City | MARION
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State | SC
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Zip | 29571-6122
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Country | US
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Telephone | 843-245-3553
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Fax |
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Authorized Official
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Title or Position | OWNER / THERAPIST
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Name | MR. LEROY TART JR.
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Credential | PTA / LMT
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Telephone | 843-245-3553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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