Organization
PREMIER PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL M. BOORMAN BS PT (CLINICAL DIRECTOR/OWNER)
(843) 797-5167
Entity
Organization
Contact information
Practice address
2070 NORTHBROOK BLVD., SUITE B6, NORTH CHARLESTON, SC 29406-9252
(843) 797-5167
(843) 797-5723
Mailing address
2070 NORTHBROOK BLVD., SUITE B6, NORTH CHARLESTON, SC 29406-9252
(843) 797-5167
(843) 797-5723
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3587
—
SC
Enumeration date
02/03/2006
Last updated
07/21/2022
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