NPIMap

Organization Active NPI

Grace Physical Therapy, LLC

  • Physical Therapist
  • Summerville, SC
National Provider Identifier
1356544415
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
3858 Issued in SC
Legal business name
GRACE PHYSICAL THERAPY, LLC
Practice address
440 Unit D Old Trolley Road
Summerville, SC 29485
Phone
(843) 871-3522
Fax
(843) 871-3523
NPI assigned
Jun 7, 2007
Last updated
Sep 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

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

Authorized official

Name
Alicia Duncan
Title
Business Manager
Phone
(843) 871-3522

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 3858 SC Primary

Addresses

Primary practice location

440 Unit D Old Trolley Road
Summerville, SC 29485

Mailing address

440 Unit D Old Trolley Road
Summerville, SC 29485
Phone (843) 871-3522

Other identifiers 1

IdentifierTypeStateIssuer
GP5224MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070808000449 SC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1557452331 Receives reassigned benefits from 8 practitioners
Practice locations: Summerville, SC

National Provider Directory

National Provider Directory

Locations

440 Old Trolley Rd
Summerville, SC 29485

440 Old Trolley Rd
Ste D
Summerville, SC 29485
Phone (843) 871-3522

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662940800000",
    "number": "1356544415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 UNIT D OLD TROLLEY ROAD",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "29485",
            "telephone_number": "843-871-3522",
            "fax_number": "843-871-3523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 UNIT D OLD TROLLEY ROAD",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "29485",
            "telephone_number": "843-871-3522",
            "fax_number": "843-871-3523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "843-871-3522"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "3858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5224",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.