Healthcare Provider Details

I. General information

NPI: 1386197309
Provider Name (Legal Business Name): LOU NELL EADY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 TRAILHEAD CT
GREENVILLE SC
29617-6226
US

IV. Provider business mailing address

845 NE MAIN ST
SIMPSONVILLE SC
29681-2041
US

V. Phone/Fax

Practice location:
  • Phone: 864-371-3100
  • Fax:
Mailing address:
  • Phone: 864-525-2654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1259
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: