Provider Demographics
NPI:1033521596
Name:LETHCO, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:LETHCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 ELMS PLANTATION BLVD
Mailing Address - Street 2:STE. C
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-7132
Mailing Address - Country:US
Mailing Address - Phone:843-974-4097
Mailing Address - Fax:843-974-4125
Practice Address - Street 1:2695 ELMS PLANTATION BLVD
Practice Address - Street 2:STE. C
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7132
Practice Address - Country:US
Practice Address - Phone:843-974-4097
Practice Address - Fax:843-974-4125
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist