Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2760 | SC |
NPI | 1396007407 |
---|---|
Provider Name | Mrs. Michele Acejo Bucayan |
First Address | Summerville, SC 29485-7850 |
Second Address | Summerville, SC 29485-8138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2012 |
Last Update Date | 14/06/2012 |