Provider Demographics
NPI:1720517279
Name:SACCO, CARLY CHRISTINE (DPT)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:CHRISTINE
Last Name:SACCO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 SHERIDAN PARK CIR STE C
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7023
Mailing Address - Country:US
Mailing Address - Phone:843-815-5628
Mailing Address - Fax:843-815-5637
Practice Address - Street 1:38 SHERIDAN PARK CIR STE C
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7023
Practice Address - Country:US
Practice Address - Phone:843-815-5628
Practice Address - Fax:843-815-5637
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist