Organization
FAITHWORKS PEDIATRIC INNERVATIONS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY MCKENZIE SPEECH PATHOLOGIST (OWNER)
(843) 394-9799
Entity
Organization
Contact information
Practice address
318 MOORE ST, LAKE CITY, SC 29560-2551
(843) 394-9799
(843) 394-9899
Mailing address
300 THURSTON ST, LAKE CITY, SC 29560-2527
(843) 394-9799
(843) 394-9899
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4703
SC
225200000X
Physical Therapy Assistant
177
SC
235Z00000X
Speech-Language Pathologist
1113
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3696
—
SC
Enumeration date
02/05/2007
Last updated
09/11/2025
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