Individual ProviderAndrew BagleyPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address104 Mallory Dr, Goose Creek, SC 29445-6406(864) 275-0740(864) 993-6304PECOS EnrollmentBased on the most recent information from CMS, provider Andrew Bagley does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1578088316Provider TypeIndividualFull NameBagley, AndrewCredentialPT, DPT, OCS, ATCGenderMaleSole ProprietorNoEnumeration Date8/12/2017Last Updated5/28/2024Contact InformationPractice LocationPractice Address104 Mallory Dr, Goose Creek, SC 29445-6406Phone(864) 275-0740Fax(843) 808-6986Mailing LocationMailing AddressPO Box 1119, Goose Creek, SC 29445-1119Phone(864) 993-6304Fax(843) 808-6986Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense10669South Carolina