Provider Demographics
NPI:1689036881
Name:CRESCENT THERAPY GROUP
Entity Type:Organization
Organization Name:CRESCENT THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PRIDGEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:803-351-7502
Mailing Address - Street 1:146 STONEMONT DR
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8665
Mailing Address - Country:US
Mailing Address - Phone:803-351-7502
Mailing Address - Fax:
Practice Address - Street 1:146 STONEMONT DR
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8665
Practice Address - Country:US
Practice Address - Phone:803-351-7502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty