Individual provider Active NPI

Kenton Holden Jr., PT,MHS,CSCS

  • Physical Therapist
  • Mt Pleasant, SC
National Provider Identifier
1497838569
Registry record updated Jun 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
3506 Issued in SC
Practice address
1476 Long Grove Dr
Suite 1
Mt Pleasant, SC 29464-7571
Phone
(843) 216-3534
NPI assigned
Oct 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 3506 SC Primary

Addresses

Primary practice location

1476 Long Grove Dr
Suite 1
Mt Pleasant, SC 29464-7571

Mailing address

1476 Long Grove Dr
Mt Pleasant, SC 29464-7571

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041022000168 SC Practitioner - Physical Therapist in Private Practice 4981664505 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Olympic Physical Therapy LLCGroup PAC ID 6800856428, 10 clinicians

Practice addresses (Care Compare)

1476 Long Grove Dr
Mount Pleasant, SC 29464-7571
Phone (843) 216-3534

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3506SCMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Olympic Physical Therapy LLC Physical Therapist CurrentSince Sep 23, 2004 Accepting new patients

Locations

1476 Long Grove Dr
Mt Pleasant, SC 29464
Phone (843) 216-3534

1476 Long Grove Dr
Ste 1
Mt Pleasant, SC 29464
Phone (843) 216-3534

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496880000000",
    "number": "1497838569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1476 LONG GROVE DR",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294647571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1476 LONG GROVE DR",
            "address_2": "SUITE 1",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294647571",
            "telephone_number": "843-216-3534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDEN",
        "first_name": "KENTON",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PT,MHS,CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2017-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "3506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Pleasant, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.