Healthcare Provider Details

I. General information

NPI: 1295771004
Provider Name (Legal Business Name): MARYDITH SPRINGS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HIGHLAND CENTER DR
COLUMBIA SC
29203-9247
US

IV. Provider business mailing address

1730B SAVANNAH HWY
CHARLESTON SC
29407-6255
US

V. Phone/Fax

Practice location:
  • Phone: 803-408-3277
  • Fax: 803-408-3299
Mailing address:
  • Phone: 843-763-4115
  • Fax: 843-766-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4715
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: