Healthcare Provider Details

I. General information

NPI: 1154665453
Provider Name (Legal Business Name): LAURA A. EISON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 N ACADEMY ST
GREENVILLE SC
29601-2629
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-331-1344
  • Fax: 864-331-1446
Mailing address:
  • Phone: 864-797-6307
  • Fax: 864-797-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6883
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: