Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 7744 | SC |
NPI | 1114306610 |
---|---|
Provider Name | Cherry Elizabeth Woodruff |
First Address | North Charleston, SC 29406-9149 |
Second Address | North Charleston, SC 29406-9149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2015 |
Last Update Date | 17/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14008186 | CAQH (01) | |
TH2920 | (05) | SC |