Organization
YOUR LIFE WELLNESS AND PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LEE ANN GASTON P. TL (OWNER/PHYSICAL THERAPIST)
(803) 548-5662
Entity
Organization
Contact information
Practice address
7580 CHARLOTTE HWY, SUITE 500, INDIAN LAND, SC 29707-7801
(803) 548-5662
(803) 548-5635
Mailing address
7580 CHARLOTTE HWY, SUITE 500, INDIAN LAND, SC 29707-7801
(803) 548-5662
(803) 548-5635
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
2342
SC
Other
Enumeration date
08/31/2012
Last updated
08/31/2012
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