Provider Demographics
NPI:1619921293
Name:JAMES ISLAND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:JAMES ISLAND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:DUFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:843-406-9889
Mailing Address - Street 1:325 FOLLY RD
Mailing Address - Street 2:
Mailing Address - City:JAMES ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29412
Mailing Address - Country:US
Mailing Address - Phone:843-406-9889
Mailing Address - Fax:843-406-7889
Practice Address - Street 1:325 FOLLY RD
Practice Address - Street 2:JAMES ISLAND PHYSICAL THERAPY
Practice Address - City:JAMES ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:843-406-9889
Practice Address - Fax:843-406-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT3683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1097Medicaid
SCTH1097Medicaid