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General NPI Number Information
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NPI Number | 1033704267
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Entity Type | Individual
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Provider Name | MICA SANON RPT
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Gender | Female
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Dates
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Enumeration Date | 03/09/2021
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 25 CASSIDY DR
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City | BLUFFTON
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State | SC
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Zip | 29910-4143
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Country | US
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Telephone | 843-396-1065
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Fax |
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Provider Business Mailing Address
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Address Line | 21 WINSLOW CIR
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City | SAVANNAH
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State | GA
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Zip | 31407-4946
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Country | US
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Telephone | 816-898-4227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT014119
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10185
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License Number State | SC
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