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General NPI Number Information
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NPI Number | 1972910529
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Entity Type | Organization
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Legal Business Name | CHARLESTON THERAPEUTIC YOGA
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 2877 DONCASTER DR
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City | CHARLESTON
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State | SC
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Zip | 29414-6737
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Country | US
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Telephone | 843-343-4206
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Fax |
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Provider Business Mailing Address
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Address Line | 2877 DONCASTER DR
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City | CHARLESTON
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State | SC
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Zip | 29414-6737
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Country | US
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Telephone | 843-343-4206
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Fax |
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Authorized Official
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Title or Position | PHYSICAL AND YOGA THERAPIST
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Name | MS. THER NICOLE CHUMLEY-JONES
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Credential | MSRPT, RYT 200
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Telephone | 843-343-4205
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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 | 5097
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License Number State | SC
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