Provider Demographics
NPI:1730725441
Name:LOWCOUNTRY PEDIATRIC PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:LOWCOUNTRY PEDIATRIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANAGAN KOKKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:843-810-3911
Mailing Address - Street 1:421 LESESNE ST
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7314
Mailing Address - Country:US
Mailing Address - Phone:843-810-3911
Mailing Address - Fax:833-787-9691
Practice Address - Street 1:421 LESESNE ST
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7314
Practice Address - Country:US
Practice Address - Phone:843-810-3911
Practice Address - Fax:833-787-9691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty