Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1758 |
NPI | 1699197152 |
---|---|
Provider Name | Keshia Mcmillian |
First Address | Columbia, SC 29209-1638 |
Second Address | Columbia, SC 29209-1638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2014 |
Last Update Date | 27/04/2014 |