Individual
TAYVIONNA ETHEREDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 DREHER ROAD, SUITE 100, WEST COLUMBIA, SC 29169
(803) 525-7080
Mailing address
100 DREHER ROAD, SUITE 100, WEST COLUMBIA, SC 29169
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PTA.5096
SC
Other
Enumeration date
04/17/2023
Last updated
04/17/2023
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