Individual
BRIANA BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3634A SUNSET BLVD, WEST COLUMBIA, SC 29169
(803) 451-0244
(803) 451-0245
Mailing address
PO BOX 3408, IRMO, SC 29063-4015
(803) 422-0247
(803) 451-0245
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8053
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8053
PT
SC
Enumeration date
03/11/2016
Last updated
03/11/2016
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