Provider Demographics
NPI:1710298831
Name:PRIDGEN, CHRISTINE KOSTURA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KOSTURA
Last Name:PRIDGEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:KOSTURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10071 BROAD RIVER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2381
Mailing Address - Country:US
Mailing Address - Phone:803-445-1069
Mailing Address - Fax:803-445-1097
Practice Address - Street 1:2720 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4810
Practice Address - Country:US
Practice Address - Phone:803-791-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist