Provider Demographics
NPI:1982130944
Name:MCCLELLANVILLE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:MCCLELLANVILLE PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:ENGLISH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-817-1925
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:SULLIVANS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29482-0598
Mailing Address - Country:US
Mailing Address - Phone:843-817-1925
Mailing Address - Fax:843-459-7917
Practice Address - Street 1:829 PINCKNEY ST
Practice Address - Street 2:
Practice Address - City:MC CLELLANVILLE
Practice Address - State:SC
Practice Address - Zip Code:29458-9744
Practice Address - Country:US
Practice Address - Phone:843-817-1925
Practice Address - Fax:844-271-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty