Individual
EBONY NICOLE THERRIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2222 SULLIVAN TRL, EASTON, PA 18040-7958
(800) 944-9782
Mailing address
385 S REVERE CV APT 108, TEGA CAY, SC 29708-8696
(706) 267-8577
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
P19788
NC
225100000X
Physical Therapist
PT8590
SC
225100000X
Physical Therapist
Primary
PTH5706
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058494112
DRIVER LICENSE
GA
01
—
PTH 5706
PROFESSIONAL LICENSE
AL
Enumeration date
07/28/2011
Last updated
06/21/2021
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