Provider Demographics
NPI:1306871439
Name:CAROLINA SPORTSCARE AND PHYSICAL THERAPY OF BLUFFTON
Entity type:Organization
Organization Name:CAROLINA SPORTSCARE AND PHYSICAL THERAPY OF BLUFFTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KONOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-706-9940
Mailing Address - Street 1:23 PLANTATION PARK DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6038
Mailing Address - Country:US
Mailing Address - Phone:843-706-9940
Mailing Address - Fax:843-706-9942
Practice Address - Street 1:23 PLANTATION PARK DR
Practice Address - Street 2:SUITE 304
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6038
Practice Address - Country:US
Practice Address - Phone:843-706-9940
Practice Address - Fax:843-706-9942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7754Medicare ID - Type Unspecified