Provider Demographics
NPI:1104086651
Name:GROWING STRONG PEDIATRIC THERAPY
Entity type:Organization
Organization Name:GROWING STRONG PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:WHITSITT
Authorized Official - Suffix:
Authorized Official - Credentials:MSR, PT
Authorized Official - Phone:843-270-1594
Mailing Address - Street 1:1535 BARQUENTINE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4900
Mailing Address - Country:US
Mailing Address - Phone:843-270-1594
Mailing Address - Fax:
Practice Address - Street 1:1535 BARQUENTINE DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4900
Practice Address - Country:US
Practice Address - Phone:843-270-1594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC55882251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty