Individual
MARY ALEXANDRA VERISSIMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
3510 PARK AVENUE BLVD STE 105, MOUNT PLEASANT, SC 29466-7361
(843) 607-4493
Mailing address
1504 FAITH ST, MOUNT PLEASANT, SC 29466-6874
(309) 369-6593
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070018923
IL
225100000X
Physical Therapist
8301
SC
2251P0200X
Pediatric Physical Therapist
070018923
IL
2251P0200X
Pediatric Physical Therapist
Primary
8301
SC
Other
Enumeration date
02/23/2012
Last updated
01/06/2025
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