Basic Information
| Provider Information | |||||||||
| NPI: | 1962687467 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFESTYLE PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4543 CHARLOTTE HWY | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | CLOVER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297107073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8038311454 | ||||||||
| FaxNumber: | 8038311455 | ||||||||
| Practice Location | |||||||||
| Address1: | 4543 CHARLOTTE HWY | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | CLOVER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297107073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8038311454 | ||||||||
| FaxNumber: | 8038311455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2008 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHULER | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7047982735 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT | ||||||||
| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 5214 | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.