NPIMap

Organization Active NPI

Coastal Play 2 Grow Therapy, LLC

  • Physical Therapist
  • Charleston, SC
National Provider Identifier
1750828364
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
COASTAL PLAY 2 GROW THERAPY, LLC
Practice address
2387 Lantern St
Charleston, SC 29414-4850
Phone
(317) 750-9879
Fax
(888) 965-4405
NPI assigned
Jan 22, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

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

Authorized official

Name
Courtney JarrardNPI 1669484093
Title
Biller
Phone
(843) 568-4786

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

2387 Lantern St
Charleston, SC 29414-4850

Mailing address

2387 Lantern St
Charleston, SC 29414-4850

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230901002952 SC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6002279320 Receives reassigned benefits from 6 practitioners
Practice locations: Charleston, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1485043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1750828364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2387 LANTERN ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294144850",
            "fax_number": "888-965-4405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2387 LANTERN ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294144850",
            "telephone_number": "317-750-9879",
            "fax_number": "888-965-4405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PLAY 2 GROW THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-22",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "JARRARD",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "843-568-4786"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; 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.