Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1871 | SC |
N | 225200000X | Physical Therapy Assistant | 18873 | FL |
NPI | 1003971391 |
---|---|
Provider Name | Mellissa Jean Hepworth |
First Address | Aiken, SC 29803-5447 |
Second Address | Aiken, SC 29801-6348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |