Individual
WALTER GERRARD NIVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
819 MCKINNEY RD, SIMPSONVILLE, SC 29681-4605
(864) 553-8290
Mailing address
819 MCKINNEY RD, SIMPSONVILLE, SC 29681-4605
(864) 553-8290
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
6830
SC
Other
Enumeration date
12/01/2022
Last updated
12/01/2022
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