MEDICARE: JONATHAN CANCIENNE PT

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	1259022	TX
2	225100000X	Physical Therapist	8840	SC
3	225100000X	Physical Therapist	09138R	LA

General Provider Information

NPI Number	:	1700269214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN CANCIENNE PT

Provider Business Mailing Address
First Line	:	537 LONG POINT RD STE 106
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-8279
Country	:	US
Telephone Number	:	843-718-2683
Fax Number	:	843-388-7149

Provider Business Practice Location Address
First Line	:	537 LONG POINT RD STE 106
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-8279
Country	:	US
Telephone Number	:	843-718-2683
Fax Number	:	843-388-7149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	01/28/2026

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Directions to “ JONATHAN CANCIENNE PT” Practice Location

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