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General NPI Number Information
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NPI Number | 1346485828
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Entity Type | Individual
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Provider Name | CONNIE E TATE L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 17 LAWTON AVE
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City | GREENVILLE
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State | SC
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Zip | 29601-2305
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Country | US
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Telephone | 864-232-7821
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Fax |
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Provider Business Mailing Address
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Address Line | 205 PETE HOLLIS BLVD
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City | GREENVILLE
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State | SC
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Zip | 29601-1155
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Country | US
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Telephone | 864-242-3707
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 4898
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License Number State | SC
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