Individual
MR. DAVID W PEGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1075 BOILING SPRINGS RD, SPARTANBURG, SC 29303-2248
(864) 580-2001
(864) 580-2003
Mailing address
PO BOX 3408, IRMO, SC 29063-4015
(803) 732-5887
(803) 732-5997
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4544
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00372305
RAILROAD MEDICARE PIN
SC
Enumeration date
11/27/2006
Last updated
05/25/2011
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