Healthcare Provider Details

I. General information

NPI: 1750853701
Provider Name (Legal Business Name): MARY ELIZABETH ROBINSON NEWTON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WELLMORE DR
LEXINGTON SC
29072-9172
US

IV. Provider business mailing address

200 WELLMORE DR
LEXINGTON SC
29072-9172
US

V. Phone/Fax

Practice location:
  • Phone: 803-500-1194
  • Fax:
Mailing address:
  • Phone: 803-500-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number7657
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: