Provider Demographics
NPI:1639102312
Name:LOW COUNTRY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LOW COUNTRY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-651-6565
Mailing Address - Street 1:2586 HIGHWAY 17 SOUTH
Mailing Address - Street 2:UNIT C&D
Mailing Address - City:GARDEN CITY BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6605
Mailing Address - Country:US
Mailing Address - Phone:843-651-6565
Mailing Address - Fax:843-651-6575
Practice Address - Street 1:2586 S HIGHWAY 17 UNIT C&D
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6605
Practice Address - Country:US
Practice Address - Phone:843-651-6565
Practice Address - Fax:843-651-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4329Medicaid
SCGP4329Medicaid