Organization
CHARLESTON PEDIATRIC REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL COYLE OTRL (OWNER)
(843) 769-0663
Entity
Organization
Contact information
Practice address
1407 ASHLEY RIVER RD, CHARLESTON, SC 29407-5305
(843) 769-0663
(843) 769-0556
Mailing address
1407 ASHLEY RIVER RD, CHARLESTON, SC 29407-5305
(843) 769-0663
(843) 769-0556
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3373
—
SC
Enumeration date
11/29/2006
Last updated
09/11/2025
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