# IMAGINE PHYSICAL THERAPY OLD VILLAGE LLC

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

## Provider details

- **NPI number:** 1477937662
- **Authorized official:** BETH WILLIAMSON (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (843) 804-9479

## Contact information

- **Practice address:** 1304 ERCKMANN DR UNIT C, MT PLEASANT, SC 29464-5536
- **Practice address phone:** (843) 971-7668
- **Practice address fax:** (843) 971-7666
- **Mailing address:** IMAGINE PHYSICAL THERAPY, 5111 NORTH RHETT AVENUE, NORTH CHARLESTON, SC 29405-4219
- **Mailing address phone:** (843) 804-9077
- **Mailing address fax:** (843) 804-9020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/17/2015
- **Last updated:** 08/03/2022