Provider Demographics
NPI:1972910529
Name:CHARLESTON THERAPEUTIC YOGA
Entity type:Organization
Organization Name:CHARLESTON THERAPEUTIC YOGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL AND YOGA THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:THER
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CHUMLEY-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MSRPT, RYT 200
Authorized Official - Phone:843-343-4205
Mailing Address - Street 1:2877 DONCASTER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6737
Mailing Address - Country:US
Mailing Address - Phone:843-343-4206
Mailing Address - Fax:
Practice Address - Street 1:2877 DONCASTER DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6737
Practice Address - Country:US
Practice Address - Phone:843-343-4206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5097261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy