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General NPI Number Information
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NPI Number | 1861678534
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Entity Type | Organization
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Legal Business Name | PATTISONS D R E A M ACADEMY
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Dates
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Enumeration Date | 01/12/2008
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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 | 843-402-7850
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Fax | 843-402-7850
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Provider Business Mailing Address
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Address Line | PO BOX 80426
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City | CHARLESTON
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State | SC
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Zip | 29416-0426
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Country | US
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Telephone | 843-402-7850
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Fax | 843-402-7851
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. LAURA GANCI
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Credential |
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Telephone | 843-402-7850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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