Individual
STACEY LYNNE SUMMEROUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 JOSEPH WALKER DR, WEST COLUMBIA, SC 29169-6939
(803) 936-0310
Mailing address
100 JOSEPH WALKER DR, WEST COLUMBIA, SC 29169-6939
(803) 936-0310
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1894
SC
Other
Enumeration date
09/20/2007
Last updated
09/20/2007
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