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General NPI Number Information
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NPI Number | 1063986040
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Entity Type | Individual
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Provider Name | SETH THOMAS FRUTIGER DPT
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Gender | Male
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Dates
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Enumeration Date | 01/14/2019
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 2611 FOREST DR STE 130
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City | COLUMBIA
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State | SC
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Zip | 29204-2372
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Country | US
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Telephone | 803-722-4996
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Fax | 803-722-6070
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Provider Business Mailing Address
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Address Line | 132 S MARION ST APT A
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City | COLUMBIA
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State | SC
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Zip | 29205-3275
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Country | US
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Telephone | 585-727-9859
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Fax | 803-732-5997
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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 | 9473
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License Number State | SC
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