Provider Demographics
NPI:1407974405
Name:SHELLEY BIRNIE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:SHELLEY BIRNIE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRNIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-884-1118
Mailing Address - Street 1:498 WANDO PARK BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7902
Mailing Address - Country:US
Mailing Address - Phone:843-884-1118
Mailing Address - Fax:843-448-2434
Practice Address - Street 1:498 WANDO PARK BLVD
Practice Address - Street 2:STE 200
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7902
Practice Address - Country:US
Practice Address - Phone:843-884-1118
Practice Address - Fax:843-448-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1042261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC610458600OtherDOL NUMBER
SC3229888OtherAETNA PROVIDER NUMBER
SC3229888OtherAETNA PROVIDER NUMBER