Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 9853 | SC |
N | 2251C2600X | Cardiopulmonary |
NPI | 1386202893 |
---|---|
Provider Name | Erin Leonard Cleveland |
First Address | Greenville, SC 29601-2842 |
Second Address | Clemson, SC 29631-2194 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2019 |
Last Update Date | 24/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TH4065 | (05) | SC |