Organization
IMAGINE PHYSICAL THERAPY OLD VILLAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETH WILLIAMSON (CREDENTIALING SPECIALIST)
(843) 804-9479
Entity
Organization
Contact information
Practice address
1304 ERCKMANN DR UNIT C, MT PLEASANT, SC 29464-5536
(843) 971-7668
(843) 971-7666
Mailing address
IMAGINE PHYSICAL THERAPY, 5111 NORTH RHETT AVENUE, NORTH CHARLESTON, SC 29405-4219
(843) 804-9077
(843) 804-9020
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP6984
—
SC
Enumeration date
07/17/2015
Last updated
08/03/2022
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