MEDICARE: PLUFF MUD THERAPY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1013232503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLUFF MUD THERAPY SERVICES

Provider Business Mailing Address
First Line	:	1849 CAPRI DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7603
Country	:	US
Telephone Number	:	843-270-8505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1849 CAPRI DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7603
Country	:	US
Telephone Number	:	843-270-8505
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAIGE POOSER MERRILL
Credential	:	OTR/L
Telephone Number	:	843-270-8505

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	02/18/2023

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