Individual
DEBRA M IACONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3799 12TH STREET EXT STE 100, CAYCE, SC 29033-3750
(803) 926-6810
(803) 926-6811
Mailing address
PO BOX 896239, CHARLOTTE, NC 28289-6239
(803) 926-6810
(803) 926-6811
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1915
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1915
LICENSE #
SC
Enumeration date
01/09/2007
Last updated
09/20/2018
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