Individual
MARDELL BATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
412 DRIVE IN LN, MONCKS CORNER, SC 29461-3160
(843) 761-6732
(843) 761-6734
Mailing address
4807 BUTTERCUP WAY, SUMMERVILLE, SC 29485-8970
(843) 412-7713
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5101
SC
Other
Enumeration date
12/16/2013
Last updated
12/16/2013
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