Individual
HEATHER DETWILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2705 LEAPHART RD., CAROLINA GARDENS, WEST COLUMBIA, SC 29169
(803) 939-3000
Mailing address
1 SWAINSON CT, IRMO, SC 29063-7808
(803) 361-8829
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3288
SC
Other
Enumeration date
03/16/2017
Last updated
03/16/2017
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