Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2554 | SC |
NPI | 1124076807 |
---|---|
Provider Name | Amber T. Reeves |
First Address | Pendleton, SC 29670-1721 |
Second Address | Pendleton, SC 29670-1721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 02/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1942275649 | (05) | SC |
TH0536 | (05) | SC |