Individual
MISS LAVIDA NOELLA AUDAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
311 SIMPSON RD, ANDERSON, SC 29621-2157
(864) 261-3875
Mailing address
311 SIMPSON RD, ANDERSON, SC 29621-2157
(864) 261-3875
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5021
SC
2251G0304X
Geriatric Physical Therapist
5021
SC
Other
Enumeration date
09/30/2009
Last updated
09/30/2009
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