MEDICARE: MISS STEPHANIE NOEL ROBERTS MUSSELMAN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	10424	SC
2	225100000X	Physical Therapist	2305203853	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790784478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STEPHANIE NOEL ROBERTS MUSSELMAN DPT

Provider Business Mailing Address
First Line	:	39 HOSPITAL CENTER CMNS
Second Line	:
City	:	HILTON HEAD
State	:	SC
Zip	:	29926-2837
Country	:	US
Telephone Number	:	843-689-2233
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 HOSPITAL CENTER CMNS
Second Line	:
City	:	HILTON HEAD
State	:	SC
Zip	:	29926-2837
Country	:	US
Telephone Number	:	843-689-2233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	01/21/2021

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