Individual
BERNUM BENJAMIN ASHLEY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
125 MALLARD DR, MOORE, SC 29369-9464
(864) 486-9585
Mailing address
125 MALLARD DR, MOORE, SC 29369-9464
(864) 486-9585
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2059
SC
Other
Enumeration date
05/16/2011
Last updated
05/16/2011
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