Individual
MICHAEL BOYRKIN FADDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT#11800
Contact information
Practice address
650 CHICKASAW DR, SUMTER, SC 29150-2237
(803) 229-7806
Mailing address
650 CHICKASAW DR, SUMTER, SC 29150-2237
(803) 229-7806
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11800
SC
Other
Enumeration date
09/13/2024
Last updated
09/13/2024
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