Provider Demographics
NPI:1366889123
Name:COLPITT, PATRICK WILLIAM (PT, DPT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:WILLIAM
Last Name:COLPITT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 MARY ADER AVE APT 916
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5791
Mailing Address - Country:US
Mailing Address - Phone:864-395-3311
Mailing Address - Fax:
Practice Address - Street 1:2070 NORTHBROOK BLVD STE B6
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9254
Practice Address - Country:US
Practice Address - Phone:843-797-5167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist