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Organization
MARLBORO PHYSICAL THERAPY
Active
Organization
MARLBORO PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDIE M STO DOMINGO (PT)
(843) 454-9000
Entity
Organization
Contact information
Practice address
1021 CHERAW ST, BENNETTSVILLE, SC 29512-2422
(843) 454-9000
(843) 454-9001
Mailing address
1021 CHERAW ST, BENNETTSVILLE, SC 29512-2422
(843) 454-9000
(843) 454-9001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TH1257
—
SC
Enumeration date
07/03/2006
Last updated
09/16/2014
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