Individual
MICHAELA TERESA ETHERIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2500 ANTHUAN MAYBANK ST, GEORGETOWN, SC 29440-2520
(843) 458-1601
Mailing address
2500 ANTHUAN MAYBANK ST, GEORGETOWN, SC 29440-2520
(843) 458-1601
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2105
SC
Other
Enumeration date
03/03/2020
Last updated
03/03/2020
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