| NPI | 1972511129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA KEZIAH SHUMATE Physical Therapist 843-409-1620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: SC 4705) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2020-08-22 |