Healthcare Provider Details

I. General information

NPI: 1619161296
Provider Name (Legal Business Name): TOCQUIN PAXTON TERRELL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 BATTLESHIP RD SPRINGDALE HEALTHCARE CENTER
CAMDEN SC
29020-2060
US

IV. Provider business mailing address

41 N HAVEN CT
COLUMBIA SC
29203-4321
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-3741
  • Fax:
Mailing address:
  • Phone: 803-422-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2124
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: