Individual
MISS STACEY RENA VANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
455 SUNNEHANNA DR, BOX 384, MYRTLE BEACH, SC 29588-5365
(843) 340-4478
Mailing address
455 SUNNEHANNA DR, BOX 384, MYRTLE BEACH, SC 29588-5365
(843) 340-4478
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1504
SC
Other
Enumeration date
05/08/2007
Last updated
09/30/2016
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