Individual
JUDIE M STO DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1021 CHERAW STREET, BENNETTSVILLE, SC 29512
(843) 454-9000
(843) 454-9001
Mailing address
1021 CHERAW STREET, BENNETTSVILLE, SC 29512
(843) 454-9000
(843) 454-9001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2904
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TH1257
—
SC
Enumeration date
07/12/2006
Last updated
11/29/2007
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