Individual
KELLY BLAKE CANTU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2000 CENTER POINT RD STE 2360, COLUMBIA, SC 29210-5826
(803) 233-5500
(803) 258-6395
Mailing address
2000 CENTER POINT RD STE 2360, COLUMBIA, SC 29210-5826
(803) 233-5500
(803) 258-6395
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
1770252017
SC
Other
Enumeration date
09/07/2007
Last updated
10/22/2024
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