Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 3143 | SC |
NPI | 1184128597 |
---|---|
Provider Name | Steven Michael Bevilacqua |
First Address | Mount Pleasant, SC 29466-8638 |
Second Address | Mount Pleasant, SC 29466-8638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2018 |
Last Update Date | 20/03/2018 |