Healthcare Provider Details

I. General information

NPI: 1437629946
Provider Name (Legal Business Name): JENNIFER FINCH AGEMA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 MCGILL LN
SAINT STEPHEN SC
29479-3196
US

IV. Provider business mailing address

122 GIBSON ST
MONCKS CORNER SC
29461-3819
US

V. Phone/Fax

Practice location:
  • Phone: 843-567-2307
  • Fax:
Mailing address:
  • Phone: 843-567-2307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2985
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: