Individual
MRS. ANN KENICK CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2705 LEAPHART RD, AGAPE THERAPY, WEST COLUMBIA, SC 29169-3335
(803) 926-5119
Mailing address
1424 SALEM CHURCH RD, IRMO, SC 29063-9120
(803) 422-9739
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1174
SC
Other
Enumeration date
11/29/2006
Last updated
07/08/2007
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