Organization
PROFESSIONAL THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIKKI CARR (OWNER)
(803) 268-2743
Entity
Organization
Contact information
Practice address
895 COLEMAN AVE, ORANGEBURG, SC 29115-3742
(803) 268-2743
Mailing address
895 COLEMAN AVE, ORANGEBURG, SC 29115-3742
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2633
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3923
—
SC
Enumeration date
04/10/2007
Last updated
08/22/2020
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