Individual
SHERMAN KEVIN BASONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
10 ENTERPRISE BLVD, STE 201, GREENVILLE, SC 29615-3554
(864) 583-0053
Mailing address
220 ROPER MOUNTAIN ROAD EXT, GREENVILLE, SC 29615-4886
(864) 242-1163
(864) 242-1167
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTLICENSE2637
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TH1959
—
SC
Enumeration date
08/04/2006
Last updated
10/11/2019
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