NPIMap

Organization Active NPI

Olympic Physical Therapy LLC

  • Physical Therapist
  • Mount Pleasant, SC
National Provider Identifier
1710060868
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
OLYMPIC PHYSICAL THERAPY LLC
Practice address
1476 Long Grove Dr
Suite 1
Mt Pleasant, SC 29464-7571
Phone
(843) 216-3534
NPI assigned
Oct 23, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Kenton Holden Jr., PTNPI 1497838569
Title
Physical Therapist
Phone
(843) 216-3534

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

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

Mailing address

1476 Long Grove Dr
Suite 1
Mt Pleasant, SC 29464-7571
Phone (843) 216-3534

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041018000427 SC Part B Supplier - Clinic/Group Practice 6800856428 Receives reassigned benefits from 10 practitioners
Practice locations: Mount Pleasant, SC

National Provider Directory

National Provider Directory

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

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710060868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": {
        "organization_name": "OLYMPIC PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLDEN",
        "authorized_official_first_name": "KENTON",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "843-216-3534",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.