Individual
MR. EDENBOROUGH GENOSA HIBIONADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3412 PICKET FENCE LN, MYRTLE BEACH, SC 29579-3323
(843) 450-4936
Mailing address
3412 PICKET FENCE LN, MYRTLE BEACH, SC 29579-3323
(843) 450-4936
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
2841
SC
Other
Enumeration date
06/06/2025
Last updated
06/06/2025
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