Longevity PT

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

4916 Issued in SC

Legal business name

LONGEVITY PT

Practice address

5524 Gallatin LN
N Charleston, SC 29420-6803

Phone

(843) 906-7169

NPI assigned

Mar 3, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dale L Kukla, P.T.

Title

Owner/Physical Therapist

Phone

(843) 906-7169

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456963200000",
    "number": "1003276049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5524 GALLATIN LN",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294206803",
            "telephone_number": "843-906-7169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5524 GALLATIN LN",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294206803",
            "telephone_number": "843-906-7169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY PT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-03",
        "last_updated": "2016-03-03",
        "status": "A",
        "authorized_official_last_name": "KUKLA",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "843-906-7169",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "SC",
            "license": "4916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in N Charleston, SC
• Providers in N Charleston, SC by specialty
• Home Health Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.