Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 849 | SC |
NPI | 1518177666 |
---|---|
Provider Name | Mr. Alan Bruce Simmerson |
First Address | Columbia, SC 29204-3706 |
Second Address | Columbia, SC 29209-1638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |