Individual
MR. ROBERT STANTON HEDSTROM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
751 BRUCE ST, CHARLESTON, SC 29412-5013
(843) 714-8403
Mailing address
751 BRUCE ST, CHARLESTON, SC 29412-5013
(843) 714-8403
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030402062
BOC
—
01
—
612
DHEC
SC
Enumeration date
10/30/2014
Last updated
10/30/2014
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