Eastern Rehabilitation Services LLC

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1008 Issued in SC

Legal business name

EASTERN REHABILITATION SERVICES LLC

Practice address

1273 Remount Rd
N Charleston, SC 29406-3439

Phone

(843) 200-1878

Fax

(843) 688-5821

NPI assigned

Nov 16, 2017

Last updated

Nov 16, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Ronald Kerry White

Title

Owner

Phone

(843) 200-1878

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467965194. Details of each certification follow.

• CCN 426631 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 426631

Legal name

EASTERN REHABILITATION SERVICES, LLC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Jan 11, 2005

Last certification

Sep 7, 2023

Ownership / control type

Proprietary

Facility address

1273 Remount Road
N Charleston, SC 29406

Locations

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

{
    "created_epoch": "1510790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510790400000",
    "number": "1467965194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1273 REMOUNT RD",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294063439",
            "telephone_number": "843-200-1878",
            "fax_number": "843-688-5821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1273 REMOUNT RD",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294063439",
            "telephone_number": "843-200-1878",
            "fax_number": "843-688-5821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN REHABILITATION SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-16",
        "last_updated": "2017-11-16",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "KERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-200-1878",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "SC",
            "license": "949",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "SC",
            "license": "1008",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "4905",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melody L Dover
• Driedlice LLC
• Diane K Dukes
• Elysa Dutton, APRN
• Susan Easterly, PHARM D
• Justin Daniel Ellett, MD, PHD
• Matthew C Erickson, P.A.-C
• Family Chiropractic of Charleston, Inc.
• Rebecca Farley
• Quinell Feder

• Physical Therapy Assistant in N Charleston, SC
• Providers in N Charleston, SC by specialty
• Physical Therapy Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.