# MARLBORO PHYSICAL THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457380123
- **Authorized official:** JUDIE M STO DOMINGO (PT)
- **Authorized official phone:** (843) 454-9000

## Contact information

- **Practice address:** 1021 CHERAW ST, BENNETTSVILLE, SC 29512-2422
- **Practice address phone:** (843) 454-9000
- **Practice address fax:** (843) 454-9001
- **Mailing address:** 1021 CHERAW ST, BENNETTSVILLE, SC 29512-2422
- **Mailing address phone:** (843) 454-9000
- **Mailing address fax:** (843) 454-9001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |

## Other

- **Enumeration date:** 07/03/2006
- **Last updated:** 09/16/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | TH1257 | — | SC |