Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 4556 | SC |
NPI | 1003403908 |
---|---|
Provider Name | Ellie Victoria Michael |
First Address | Fountain Inn, SC 29644-8506 |
Second Address | Greer, SC 29650-4139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/12/2020 |
Last Update Date | 25/12/2020 |