Individual
STEPHANIE SUZANNE GILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
411 BIRCHBARK LN, LYMAN, SC 29365-1356
(585) 747-4704
Mailing address
411 BIRCHBARK LN, LYMAN, SC 29365-1356
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
032914-1
NY
225100000X
Physical Therapist
Primary
6278PT
SC
Other
Enumeration date
08/11/2010
Last updated
03/18/2013
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