Provider Demographics
NPI:1467877092
Name:COMMUNITY CARE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-200-2321
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-0845
Mailing Address - Country:US
Mailing Address - Phone:843-200-2321
Mailing Address - Fax:
Practice Address - Street 1:1828 HUBBELL DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-9212
Practice Address - Country:US
Practice Address - Phone:843-200-2321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty