Provider Demographics
NPI:1306890579
Name:PEDIATRIC PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:PEDIATRIC PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:COTTER
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-769-7773
Mailing Address - Street 1:1319 SAVANNAH HWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7848
Mailing Address - Country:US
Mailing Address - Phone:843-769-7773
Mailing Address - Fax:843-329-4043
Practice Address - Street 1:1319 SAVANNAH HWY
Practice Address - Street 2:SUITE D
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7848
Practice Address - Country:US
Practice Address - Phone:843-769-7773
Practice Address - Fax:843-329-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC505261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy