Provider Demographics
NPI:1245554104
Name:LOWCOUNTRY THERAPY CENTER, LLC
Entity type:Organization
Organization Name:LOWCOUNTRY THERAPY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FUSTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:732-762-5572
Mailing Address - Street 1:PO BOX 2421
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8967
Mailing Address - Country:US
Mailing Address - Phone:843-970-2899
Mailing Address - Fax:843-815-6998
Practice Address - Street 1:254 RED CEDAR STREET, SUITE 9
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8967
Practice Address - Country:US
Practice Address - Phone:843-970-2899
Practice Address - Fax:843-815-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 235Z00000X
SC4245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty