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General NPI Number Information
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NPI Number | 1619101151
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Entity Type | Individual
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Provider Name | MS. REGINA ANN KODER
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Gender | Female
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 3400 FOREST DR SUITE 2072
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City | COLUMBIA
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State | SC
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Zip | 29204-4041
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Country | US
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Telephone | 803-427-5403
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Fax | 803-438-8626
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Provider Business Mailing Address
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Address Line | 401 OLD BRASS DR
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City | COLUMBIA
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State | SC
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Zip | 29229-6535
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Country | US
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Telephone | 803-427-5403
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Fax | 803-438-8626
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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 | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 3428
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License Number State | SC
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