Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3445 | SC |
N | 2251X0800X | Physical Therapist - Orthopedic | 3445 | SC |
NPI | 1013001981 |
---|---|
Provider Name | Tammy C Gantzer |
First Address | Fort Mill, SC 29708-8561 |
Second Address | Rock Hill, SC 29732-1178 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 22/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GP4586 | (05) | SC |