Duckett Physical Therapy & Sports Rehab Center

Primary specialty

SpecialistTaxonomy code 174400000X

License

1458 Issued in SC

Legal business name

DUCKETT PHYSICAL THERAPY & SPORTS REHAB CENTER

Practice address

1620 Broughton St.
Orangeburg, SC 29115

Phone

(803) 534-4050

Fax

(803) 534-0408

NPI assigned

Oct 10, 2006

Last updated

Aug 22, 2020By 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

Mr. Dwayne M. Duckett, PT, MTCNPI 1366770968

Title

Owner/Director

Phone

(803) 534-4050

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720176241. Details of each certification follow.

• CCN 426592 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 426592

Legal name

DUCKETT PHYSICAL THERAPY AND SPORTS REHAB CENTER

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Apr 17, 1996

Last certification

Dec 18, 2023

Ownership / control type

Proprietary

Facility address

1620 Broughton Street PO Box 2429
Orangeburg, SC 29115

Practitioners 1

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.

• Dwayne M Duckett, P.T.

  • Physical Therapist
  • Orangeburg, SC
  • NPI 1366770968
  NPD Authorized official

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720176241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 BROUGHTON ST.",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "29115",
            "telephone_number": "803-534-4050",
            "fax_number": "803-534-0408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 BROUGHTON ST.",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "29115",
            "telephone_number": "803-534-4050",
            "fax_number": "803-534-0408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUCKETT PHYSICAL THERAPY & SPORTS REHAB CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUCKETT",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "803-534-4050",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, MTC"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "SC",
            "license": "1458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dr. David R. Hutto DMD
• Dr. Spencer C Disher
• Benjamin J. Droisen, MD
• DRS Williamson & Gillespie PA
• DRS. Williamson & Gillespie, PA
• Dwayne M Duckett, P.T.
• Tracey Duke, MSW
• Laura Dukes, PT
• Shanel R Dunkin
• Dunlap Chiropractic

• Specialist in Orangeburg, SC
• Providers in Orangeburg, SC by specialty
• Specialist in South Carolina

• 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; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.