Organization
LONGEVITY PT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE L KUKLA P.T. (OWNER/PHYSICAL THERAPIST)
(843) 906-7169
Entity
Organization
Contact information
Practice address
5524 GALLATIN LN, N CHARLESTON, SC 29420-6803
(843) 906-7169
Mailing address
5524 GALLATIN LN, N CHARLESTON, SC 29420-6803
(843) 906-7169
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
4916
SC
Other
Enumeration date
03/03/2016
Last updated
03/03/2016
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