Provider Demographics
NPI:1902052178
Name:FREDERICKS, DENISE B (PT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:B
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 OAK ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-9519
Mailing Address - Country:US
Mailing Address - Phone:843-762-6793
Mailing Address - Fax:843-762-1154
Practice Address - Street 1:1636 OAK ISLAND DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-9519
Practice Address - Country:US
Practice Address - Phone:843-762-6793
Practice Address - Fax:843-762-1154
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist