Provider Demographics
NPI:1740296003
Name:CORREIA, STEPHEN (PT PHYSICAL THERAPY)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:CORREIA
Suffix:
Gender:M
Credentials:PT PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 CROWN REACH
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7921
Mailing Address - Country:US
Mailing Address - Phone:843-364-7206
Mailing Address - Fax:
Practice Address - Street 1:3401 SALTERBECK ST STE 104
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7168
Practice Address - Country:US
Practice Address - Phone:843-364-7206
Practice Address - Fax:843-884-6635
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00433096OtherRAILROAD MEDICARE
SCGP1753Medicaid
SCTH0690Medicaid
SCQ344008702Medicare PIN
426567Medicare ID - Type Unspecified