Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1077 | SC |
NPI | 1003268111 |
---|---|
Provider Name | Scott Sherrill |
First Address | Columbia, SC 29201-2818 |
Second Address | Rock Hill, SC 29732-2336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2016 |
Last Update Date | 13/07/2016 |