Individual
MR. DUSTIN AZEVEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
109 BEE ST, CHARLESTON, SC 29401-5703
(843) 789-7111
Mailing address
109 BEE ST, CHARLESTON, SC 29401-5703
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
6235
SC
Other
Enumeration date
06/22/2021
Last updated
06/22/2021
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