Provider Demographics
NPI:1477503613
Name:PALMETTO CHILDREN'S THERAPY, LLC
Entity Type:Organization
Organization Name:PALMETTO CHILDREN'S THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:KELLEY
Authorized Official - Last Name:BEASENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-259-4633
Mailing Address - Street 1:636 LONG POINT RD UNIT G
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8286
Mailing Address - Country:US
Mailing Address - Phone:843-259-4633
Mailing Address - Fax:843-388-4498
Practice Address - Street 1:856 GRANNYS LN
Practice Address - Street 2:
Practice Address - City:AWENDAW
Practice Address - State:SC
Practice Address - Zip Code:29429-6060
Practice Address - Country:US
Practice Address - Phone:843-259-4633
Practice Address - Fax:843-388-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42362251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4271Medicaid