Individual
LAURA ELIZABETH THEISMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
1931 BULL ST, COLUMBIA, SC 29201-2560
(678) 414-3042
Mailing address
202 STONEWALL ST, HARTSVILLE, SC 29550-8765
(843) 713-6982
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
09094
—
Other
Enumeration date
09/11/2012
Last updated
04/24/2013
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