Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1324 | SC |
NPI | 1366833279 |
---|---|
Provider Name | Cindy Matthews-Long |
First Address | Columbia, SC 29205-2063 |
Second Address | Columbia, SC 29205-2063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2015 |
Last Update Date | 13/02/2015 |