Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 3104 | SC |
NPI | 1003004367 |
---|---|
Provider Name | Mr. Bruce Alan Reeves |
First Address | Charleston, SC 29425-8905 |
Second Address | Charleston, SC 29425-8905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2007 |
Last Update Date | 11/10/2007 |