Active NPI
Denise B. Fredericks, P.T.
- Physical Therapist
- Charleston, SC
National Provider Identifier
1902052178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1623
- Practice address
- 1636 Oak Island Dr
Charleston, SC 29412-9519 - Phone
- (843) 762-6793
- Fax
- (843) 762-1154
- NPI assigned
- Aug 7, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1623 | SC | Primary |
Addresses
Primary practice location
1636 Oak Island Dr
Charleston, SC 29412-9519
Mailing address
1636 Oak Island Dr
Charleston, SC 29412-9519
Phone (843) 762-6793
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1623 | SC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Denise B. Fredericks, PT, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Charleston, SC
- NPI 1407825706
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218067200000",
"number": "1902052178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1636 OAK ISLAND DR",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294129519",
"telephone_number": "843-762-6793",
"fax_number": "843-762-1154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1636 OAK ISLAND DR",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294129519",
"telephone_number": "843-762-6793",
"fax_number": "843-762-1154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICKS",
"first_name": "DENISE",
"middle_name": "B.",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-07",
"last_updated": "2008-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "1623",
"primary": true
}
],
"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 Aug 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.