Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 20714 | MA |
Y | 225100000X | Physical Therapist | 7162 | SC |
NPI | 1003249673 |
---|---|
Provider Name | Mr. James St. Cyr |
First Address | Clemson, SC 29633-1844 |
Second Address | Little River, SC 29566-6444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2013 |
Last Update Date | 23/09/2013 |