Individual provider Active NPI

Hannah Wilkerson

  • Physical Therapist
  • Lake Wylie, SC
National Provider Identifier
1629796354
Registry record updated Aug 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11521 Issued in SC
Practice address
439 Channel Rd Ste 102
Lake Wylie, SC 29710-6101
Phone
(803) 746-7800
NPI assigned
Aug 18, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11521 SC Primary
Pediatric Physical Therapist 2251P0200X

Addresses

Primary practice location

439 Channel Rd Ste 102
Lake Wylie, SC 29710-6101

Mailing address

1311 Mamaroneck Ave Ste 140
White Plains, NY 10605-5224

Other practice location 1

252 Latitude Ln Ste 103
Lake Wylie, SC 29710-8152
Phone (803) 818-0218

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231007000849 SC Practitioner - Physical Therapist in Private Practice 2860847050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of South Carolina School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Focus, Inc.Group PAC ID 5890851406, 39 clinicians

Practice addresses (Care Compare)

439 Channel Rd
Suite 102
Lake Wylie, SC 29710-6101
Phone (803) 746-7800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11521SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Focus, Inc. Physical Therapist CurrentSince Aug 22, 2023 Accepting new patients
Ivyrehab Focus, Inc. CurrentSince Aug 22, 2023 Accepting new patients

Locations

1311 Mamaroneck Ave
Ste 140
White Plains, NY 10605
Phone (914) 265-4838

439 Channel Rd
Ste 102
Lake Wylie, SC 29710
Phone (619) 977-0480

1738 Celanese Rd
#102
Rock Hill, SC 29732
Phone (803) 670-3067

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1660780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785888000000",
    "number": "1629796354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "439 CHANNEL RD STE 102",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "297106101",
            "telephone_number": "803-746-7800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "252 Latitude Ln Ste 103",
            "address_purpose": "LOCATION",
            "city": "Lake Wylie",
            "state": "SC",
            "postal_code": "297108152",
            "country_code": "US",
            "telephone_number": "803-818-0218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "HANNAH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-18",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "11521",
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Wylie, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; 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.