Provider Demographics
NPI:1730905290
Name:BE RESILIENT PHYSICAL THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:BE RESILIENT PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:803-521-8695
Mailing Address - Street 1:11 TOWNPARK LN APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-1520
Mailing Address - Country:US
Mailing Address - Phone:803-521-8695
Mailing Address - Fax:
Practice Address - Street 1:11 TOWNPARK LN APT A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-1520
Practice Address - Country:US
Practice Address - Phone:803-521-8695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy