Individual
MR. KEVIN USIF ENNIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
A.T.,C.
Contact information
Practice address
1076 RIBAUT RD, SUITE 102, BEAUFORT, SC 29902-5476
(843) 521-1970
(843) 521-0908
Mailing address
717 JANE WAY, BEAUFORT, SC 29902-6009
(843) 252-1142
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
035
SC
Other
Enumeration date
07/26/2005
Last updated
07/08/2007
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