Individual
LAURA SUSAN WITHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
681 SILVER BLUFF RD, SUITE A, AIKEN, SC 29803-4709
(803) 649-9797
Mailing address
681 SILVER BLUFF RD, SUITE A, AIKEN, SC 29803-4709
(803) 649-9797
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4880
SC
225100000X
Physical Therapist
PT008511
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4880
PHYSICAL THERAPY LICENSE
SC
01
—
PT008511
PHYSICAL THERAPY LICENSE
GA
Enumeration date
10/17/2006
Last updated
12/11/2007
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