Provider Demographics
NPI:1669489910
Name:JAMES ISLAND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:JAMES ISLAND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:DUFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC
Authorized Official - Phone:843-406-9889
Mailing Address - Street 1:8 SAWGRASS RD
Mailing Address - Street 2:SUITEB
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2523
Mailing Address - Country:US
Mailing Address - Phone:843-406-9889
Mailing Address - Fax:843-406-7889
Practice Address - Street 1:8 SAWGRASS RD
Practice Address - Street 2:SUITEB
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2523
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:2006-08-01
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT3683174400000X
SCPT5322174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherGROUP PROVIDER NUMBER
SC=========OtherGROUP PROVIDER NUMBER