Provider Demographics
NPI:1942454145
Name:ISLAND P.T.,LLC
Entity Type:Organization
Organization Name:ISLAND P.T.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SESSIONS
Authorized Official - Suffix:
Authorized Official - Credentials:MSR-PT
Authorized Official - Phone:843-744-5527
Mailing Address - Street 1:4600 GOER DR STE 205
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-6536
Mailing Address - Country:US
Mailing Address - Phone:843-744-5527
Mailing Address - Fax:843-746-9246
Practice Address - Street 1:4600 GOER DR STE 205
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6536
Practice Address - Country:US
Practice Address - Phone:843-744-5527
Practice Address - Fax:843-746-9246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ350719189Medicare PIN