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NPI Code Detail

MEDICARE: NORTHBRIDGE PHYSICAL THERAPY LLC

MEDICARE: NORTHBRIDGE PHYSICAL THERAPY LLC
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
1261QP2000XPhysical Therapy Clinic/Center1319SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11982741963OTHERSCPERSONAL NPI

General Provider Information

NPI Number : 1447428982
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHBRIDGE PHYSICAL THERAPY LLC
Provider Business Mailing Address
First Line : PO BOX 31833
Second Line :
City : CHARLESTON
State : SC
Zip : 29417-1833
Country : US
Telephone Number : 843-571-0877
Fax Number : 843-571-0844
Provider Business Practice Location Address
First Line : 1350 ASHLEY RIVER RD
Second Line : SUITE B
City : CHARLESTON
State : SC
Zip : 29407-5373
Country : US
Telephone Number : 843-571-0877
Fax Number : 843-571-0844
Authorized Official
Title or Position : OWNER NORTHBRIDGE PT
Name : MS. SUSAN RAGSDALE KING
Credential : PHYSICAL THERAPISTPT
Telephone Number : 843-343-5108
Provider Enumeration Date : 02/19/2008
Last Update Date : 03/07/2008

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Directions to “NORTHBRIDGE PHYSICAL THERAPY LLC ” Practice Location

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