Healthcare Provider Details

I. General information

NPI: 1730045337
Provider Name (Legal Business Name): TADAPONG SUWANRAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 8TH DIVISION RD, COLUMBIA, SC 29207
APO AA
29229
US

IV. Provider business mailing address

4500 8TH DIVISION RD, COLUMBIA, SC 29207
APO AA
29229
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-2408
  • Fax:
Mailing address:
  • Phone: 803-751-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1623274892
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: