Provider Demographics
NPI:1720494990
Name:GREENHALGH, CORTLAN ROBERT (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CORTLAN
Middle Name:ROBERT
Last Name:GREENHALGH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8483 YADKIN CIR
Mailing Address - Street 2:UNIT C
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9545
Mailing Address - Country:US
Mailing Address - Phone:803-603-0656
Mailing Address - Fax:
Practice Address - Street 1:8483 YADKIN CIR
Practice Address - Street 2:UNIT C
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9545
Practice Address - Country:US
Practice Address - Phone:803-603-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist