Provider Demographics
NPI:1306288261
Name:TRIPLE CROWN OF MT PLEASANT LLC
Entity type:Organization
Organization Name:TRIPLE CROWN OF MT PLEASANT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER & OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-388-3120
Mailing Address - Street 1:999 LAKE HUNTER CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5427
Mailing Address - Country:US
Mailing Address - Phone:843-388-3120
Mailing Address - Fax:
Practice Address - Street 1:999 LAKE HUNTER CIR
Practice Address - Street 2:SUITE B
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5427
Practice Address - Country:US
Practice Address - Phone:843-388-3120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-20
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy