Individual
TEQUILA KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
567 N OKATIE HWY, RIDGELAND, SC 29936-5078
(843) 476-0736
Mailing address
108 LAKEWAY DR, BLUFFTON, SC 29910-4411
(843) 476-0736
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3934
SC
Other
Enumeration date
07/18/2024
Last updated
07/18/2024
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