Individual
RANDY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1102 W MAIN ST, LAURENS, SC 29360-2610
(864) 640-1586
Mailing address
1102 W MAIN ST, LAURENS, SC 29360-2610
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2344
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881831170
EMPLOYER
SC
Enumeration date
11/14/2016
Last updated
11/14/2016
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