Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT.10101 | SC |
NPI | 1114559192 |
---|---|
Provider Name | Stephen Bendziewicz |
First Address | Irmo, SC 29063-7838 |
Second Address | Irmo, SC 29063-7838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2020 |
Last Update Date | 07/02/2020 |