Organization
CAROLINA PEDIATRIC THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA JOHNSON MA,CCC-SLP (OWNER/SPEECH LANGUAGE PATHOLOGIST)
(803) 942-0532
Entity
Organization
Contact information
Practice address
1000 PINE ST W, VARNVILLE, SC 29944-4750
(803) 942-0532
Mailing address
PO BOX 368, HAMPTON, SC 29924-0368
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5345
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA1505
—
SC
Enumeration date
11/02/2016
Last updated
11/02/2016
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