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Organization
OKATIE PHYSICAL THERAPY AND SPORTS MEDICINE
Active
Organization
OKATIE PHYSICAL THERAPY AND SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
J. ROBERT GAVIN MD (OWNER)
(843) 645-2668
Entity
Organization
Contact information
Practice address
149 RIVERWALK BLVD STE 3, RIDGELAND, SC 29936-8191
(843) 645-2668
Mailing address
15 MOSS CREEK VLG, HILTON HEAD, SC 29926-1105
(843) 681-5077
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
NULL
Other
Enumeration date
07/30/2019
Last updated
07/30/2019
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