Healthcare Provider Details

I. General information

NPI: 1851560742
Provider Name (Legal Business Name): JOANNE MIZELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 BACONS BRIDGE RD
SUMMERVILLE SC
29485-4102
US

IV. Provider business mailing address

634 BACONS BRIDGE RD
SUMMERVILLE SC
29485-4102
US

V. Phone/Fax

Practice location:
  • Phone: 843-821-2272
  • Fax:
Mailing address:
  • Phone: 843-821-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2150
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: