Imagine Physical Therapy Old Village LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

IMAGINE PHYSICAL THERAPY OLD VILLAGE LLC

Practice address

1304 Erckmann Dr Unit C
Mt Pleasant, SC 29464-5536

Phone

(843) 971-7668

Fax

(843) 971-7666

NPI assigned

Jul 17, 2015

Last updated

Aug 3, 2022By 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

Beth Williamson

Title

Credentialing Specialist

Phone

(843) 804-9479

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 24

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.

• Wehme Carolyn Hutto

  • Physical Therapist
  • Mount Pleasant, SC
  • NPI 1619416336
  Medicare reassignment Care Compare group NPD
• John Mart

  • Physical Therapist
  • Mount Pleasant, SC
  • NPI 1144255167
  Medicare reassignment Care Compare group NPD
• Alix Schoenfeld

  • Physical Therapist
  • Summerville, SC
  • NPI 1134993660
  Medicare reassignment Care Compare group NPD
• Macy N Alexander, DPT

  • Physical Therapist
  • Mount Pleasant, SC
  • NPI 1215684121
  Medicare reassignment NPD
• Carl Gabriel Botero, PT, DPT

  • Physical Therapist
  • Mount Pleasant, SC
  • NPI 1205564473
  Medicare reassignment NPD
• Aliece Wilson Christopher, PT

  • Physical Therapist
  • Daniel Island, SC
  • NPI 1598161259
  Medicare reassignment NPD
• Victoria Rose Conroy, DPT

  • Physical Therapist
  • Mount Pleasant, SC
  • NPI 1730818923
  Medicare reassignment NPD
• Breland Green, PT, DPT

  • Physical Therapist
  • Summerville, SC
  • NPI 1457034811
  Medicare reassignment NPD
• Ryan Patrick Hill, DPT

  • Physical Therapist
  • Ladson, SC
  • NPI 1679860647
  Medicare reassignment NPD
• Samuel Collins Jackson, DPT

  • Physical Therapist
  • Greenville, SC
  • NPI 1811511199
  Medicare reassignment NPD
• Brianna Hope Johnson, DPT

  • Physical Therapist
  • Charleston, SC
  • NPI 1073357117
  Medicare reassignment NPD
• Apsley Allen Milford, DPT

  • Physical Therapist
  • Mount Pleasant, SC
  • NPI 1770107559
  Medicare reassignment NPD

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1477937662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "IMAGINE PHYSICAL THERAPY",
            "address_2": "5111 NORTH RHETT AVENUE",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294054219",
            "telephone_number": "843-804-9077",
            "fax_number": "843-804-9020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 ERCKMANN DR UNIT C",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294645536",
            "telephone_number": "843-971-7668",
            "fax_number": "843-971-7666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE PHYSICAL THERAPY OLD VILLAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "843-804-9479"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6984",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Guy Edward Ilagan, PH.D, LPCS, NBCC
• Jill Crystal Payne Ilagan, PSY.D.
• Caroline Ilderton, M.A., LPC
• Imagine Chiropractic PC (Pain Relief Center of Mount Pleasant)
• Imagine Physical Therapy LLC
• Rosemarie Imburgia
• Impact Therapy, LLC
• Independent Laboratory Medicine LLC
• Independent Optical
• Indigo Health, LLC

• Physical Therapy Clinic/Center in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Physical Therapy Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.