Individual
JENNIFER MELISSA NEWSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
120C SPRINGHALL DR, GOOSE CREEK, SC 29445-5335
(843) 216-0290
Mailing address
532 COUNTRY PLACE RD, MOUNT PLEASANT, SC 29464-8258
(501) 339-7400
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT 6673
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5T910
BLUE CROSS BLUE SHIELD
AR
Enumeration date
07/16/2012
Last updated
07/16/2012
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