Provider Demographics
NPI:1639460330
Name:CAROLINA PEDIATRIC THERAPY INC
Entity Type:Organization
Organization Name:CAROLINA PEDIATRIC THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PRIGANC
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:843-455-2415
Mailing Address - Street 1:538 WILD HORSE CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-7577
Mailing Address - Country:US
Mailing Address - Phone:843-455-2415
Mailing Address - Fax:843-903-2742
Practice Address - Street 1:538 WILD HORSE CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-7577
Practice Address - Country:US
Practice Address - Phone:843-455-2415
Practice Address - Fax:843-903-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3841225100000X
SC2608225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3841OtherSOUTH CAROLINA BOARD OF PHYSICAL THERAPY EXAMINERS