Provider Demographics
NPI:1710075700
Name:MANHEIM, CAROL J (PT,LPC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:J
Last Name:MANHEIM
Suffix:
Gender:F
Credentials:PT,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CARRIAGE LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6077
Mailing Address - Country:US
Mailing Address - Phone:843-556-6363
Mailing Address - Fax:843-556-6363
Practice Address - Street 1:12 CARRIAGE LN
Practice Address - Street 2:SUITE C
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6077
Practice Address - Country:US
Practice Address - Phone:843-556-6363
Practice Address - Fax:843-556-6363
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2579101YP2500X
SC611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1340Medicaid
SCQ24308Medicare UPIN
SCGP1340Medicaid