Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1456 | SC |
NPI | 1013135185 |
---|---|
Provider Name | Kelli Anthony |
First Address | Boston, MA 02284-3446 |
Second Address | Columbia, SC 29203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1314 | SC LICENSE (01) | SC |