Provider Demographics
NPI:1447428982
Name:NORTHBRIDGE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:NORTHBRIDGE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER NORTHBRIDGE PT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:RAGSDALE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPISTPT
Authorized Official - Phone:843-343-5108
Mailing Address - Street 1:PO BOX 31833
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-1833
Mailing Address - Country:US
Mailing Address - Phone:843-571-0877
Mailing Address - Fax:843-571-0844
Practice Address - Street 1:1350 ASHLEY RIVER RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5373
Practice Address - Country:US
Practice Address - Phone:843-571-0877
Practice Address - Fax:843-571-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1319261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1982741963OtherPERSONAL NPI