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Individual

STACIE MICHELLE WILLOUGHBY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2880 TRICOM ST STE B, NORTH CHARLESTON, SC 29406-9171
(843) 553-6343
(843) 553-6404
Mailing address
182 ANTEBELLUM WAY, SUMMERVILLE, SC 29483-8147

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1922
SC

Other

Enumeration date
11/20/2006
Last updated
07/08/2007
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