NPIMap

Organization Active NPI

Lifestyle Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Clover, SC
National Provider Identifier
1962687467
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
5214 Issued in SC
Legal business name
LIFESTYLE PHYSICAL THERAPY, LLC
Practice address
4543 Charlotte Hwy
Suite 11
Clover, SC 29710-7073
Phone
(803) 831-1454
Fax
(803) 831-1455
NPI assigned
Jan 2, 2008
Last updated
Sep 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Authorized official

Name
Karen S Shuler, PT, DPTNPI 1346435948
Title
Owner
Phone
(704) 798-2735

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 Therapy Clinic/Center 261QP2000X 5214 SC Primary

Addresses

Primary practice location

4543 Charlotte Hwy
Suite 11
Clover, SC 29710-7073

Mailing address

4543 Charlotte Hwy
Suite 11
Clover, SC 29710-7073
Phone (803) 831-1454

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080108000025 SC Part B Supplier - Clinic/Group Practice 2961582622 Receives reassigned benefits from 6 practitioners
Practice locations: Lake Wylie, SC

National Provider Directory

National Provider Directory

Locations

4543 Charlotte Hwy
Ste 11
Lake Wylie, SC 29710
Phone (803) 831-1454

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1962687467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4543 CHARLOTTE HWY",
            "address_2": "SUITE 11",
            "city": "CLOVER",
            "state": "SC",
            "postal_code": "297107073",
            "telephone_number": "803-831-1454",
            "fax_number": "803-831-1455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4543 CHARLOTTE HWY",
            "address_2": "SUITE 11",
            "city": "CLOVER",
            "state": "SC",
            "postal_code": "297107073",
            "telephone_number": "803-831-1454",
            "fax_number": "803-831-1455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-02",
        "last_updated": "2023-09-06",
        "certification_date": "2022-08-05",
        "status": "A",
        "authorized_official_last_name": "SHULER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-798-2735",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "SC",
            "license": "5214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clover, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 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.