NPIMap

Organization Active NPI

Imagine Physical Therapy on Daniel Island LLC

  • Physical Therapy Clinic/Center
  • Charleston, SC
National Provider Identifier
1972770733
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
IMAGINE PHYSICAL THERAPY ON DANIEL ISLAND LLC
Practice address
142 Sportsman Island Drice
Ste F
Charleston, SC 29492
Phone
(843) 377-8820
Fax
(843) 804-9020
NPI assigned
May 12, 2008
Last updated
Aug 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Authorized official

Name
Beth Williamson
Title
Credentialing Specialist
Phone
(843) 804-9479

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

142 Sportsman Island Drice
Ste F
Charleston, SC 29492

Mailing address

Imagine Physical Therapy
5111 North Rhett Avenue
North Charleston, SC 29405-4219
Phone (843) 804-9077

Other identifiers 1

IdentifierTypeStateIssuer
GP5119MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080812000702 SC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9133294077 Receives reassigned benefits from 18 practitioners
Practice locations: Charleston, SC

National Provider Directory

National Provider Directory

Locations

295 Seven Farms Dr
Ste 200B
Daniel Island, SC 29492
Phone (843) 377-8820

295 Seven Farms Dr
Ste 206
Daniel Island, SC 29492

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1972770733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "IMAGINE PHYSICAL THERAPY",
            "address_2": "5111 NORTH RHETT AVENUE",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294054219",
            "telephone_number": "843-804-9077",
            "fax_number": "843-377-8823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 SPORTSMAN ISLAND DRICE",
            "address_2": "STE F",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29492",
            "telephone_number": "843-377-8820",
            "fax_number": "843-804-9020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE PHYSICAL THERAPY ON DANIEL ISLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-12",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "843-804-9479"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5119",
            "state": "SC"
        }
    ],
    "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 3, 2022; 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.