Individual
MARY GASTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4401 BELLE OAKS DR, NORTH CHARLESTON, SC 29405-8537
(803) 374-6255
Mailing address
4401 BELLE OAKS DR, NORTH CHARLESTON, SC 29405-8537
(803) 374-6255
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
3828
SC
225100000X
Physical Therapist
Primary
3828
SC
Other
Enumeration date
11/25/2014
Last updated
01/19/2022
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