# LIVE OAKS PHYSICAL THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Live Oaks Physical Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720035462
- **Authorized official:** ALLYSON GRAVES BENSCH PT (PRESIDENT)
- **Authorized official phone:** (843) 717-2400

## Contact information

- **Practice address:** 8084 E MAIN ST, SUITE A, RIDGELAND, SC 29936-8599
- **Practice address phone:** (843) 717-2400
- **Practice address fax:** (843) 717-2500
- **Mailing address:** 8084 E MAIN ST STE A, SUITE A, RIDGELAND, SC 29936-8667
- **Mailing address phone:** (843) 717-2400
- **Mailing address fax:** (843) 717-2500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 1369 | SC | Yes |

## Other

- **Enumeration date:** 05/28/2006
- **Last updated:** 09/30/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1369 | LICENSE | SC |