Individual
VICKY WALESCA DE MICCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
731 POLO RD, COLUMBIA, SC 29223-4462
(803) 238-5635
Mailing address
731 POLO RD, COLUMBIA, SC 29223-4462
(803) 238-5635
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
40QA01343000
NJ
225100000X
Physical Therapist
Primary
7989
SC
Other
Enumeration date
03/22/2012
Last updated
10/12/2016
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