Provider Demographics
NPI:1336346436
Name:J. SUZANNE CHERRY, PT
Entity Type:Organization
Organization Name:J. SUZANNE CHERRY, PT
Other - Org Name:DANIEL ISLAND PEDIATRIC PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-270-8947
Mailing Address - Street 1:149 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7515
Mailing Address - Country:US
Mailing Address - Phone:843-270-8947
Mailing Address - Fax:843-747-8504
Practice Address - Street 1:149 SCOTT ST
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7515
Practice Address - Country:US
Practice Address - Phone:843-270-8947
Practice Address - Fax:843-747-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17812251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTHO667Medicaid