Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2422 | SC |
NPI | 1003109257 |
---|---|
Provider Name | Mr. Michael John Teachey |
First Address | Lexington, SC 29073-9471 |
Second Address | Columbia, SC 29223-4462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2011 |
Last Update Date | 20/05/2011 |