Blue Ridge Physical Therapy, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

BLUE RIDGE PHYSICAL THERAPY, LLC

Doing business as

Blue Ridge Physical Therapy

Practice address

111 Moccasin Run
Sunset, SC 29685-2507

Phone

(843) 532-1339

NPI assigned

Aug 21, 2023

Last updated

Sep 6, 2023By 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

Carolyn Gilliam, DPT

Title

Owner, Physical Therapist

Phone

(843) 532-1339

Specialties & licenses 1

Addresses

Other names 1

• Blue Ridge Physical Therapy Doing business as

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

{
    "created_epoch": "1692576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1578347712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 MOCCASIN RUN",
            "city": "SUNSET",
            "state": "SC",
            "postal_code": "296852507",
            "telephone_number": "843-532-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MOCCASIN RUN",
            "city": "SUNSET",
            "state": "SC",
            "postal_code": "296852507",
            "telephone_number": "843-532-1339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-21",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "GILLIAM",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "OWNER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "843-532-1339",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Ridge Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blue Ridge Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kenneth Clarke Kunze, MD
• Stephanie Anne Manceor, PA-C

• Physical Therapy Clinic/Center in Sunset, SC
• Providers in Sunset, 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 Sep 6, 2023; 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.