| NPI | 1700079977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON MICHELLE WYONT President 843-230-2715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: SC 2106) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2007-08-21 |