Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 8250 | SC |
NPI | 1366990558 |
---|---|
Provider Name | Kaci Adams |
First Address | Bluffton, SC 29910-9505 |
Second Address | Bluffton, SC 29910-4845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2016 |
Last Update Date | 15/09/2016 |