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General NPI Number Information
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NPI Number | 1679829840
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Entity Type | Organization
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Legal Business Name | SEABROOK ISLAND WELLNESS INCORPORATED
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 164 MARKET ST SUITE 292
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City | CHARLESTON
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State | SC
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Zip | 29401-6948
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Country | US
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Telephone | 843-300-9626
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Fax |
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Provider Business Mailing Address
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Address Line | 4430 BETSY KERRISON PKWY SUITE A
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City | JOHNS ISLAND
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State | SC
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Zip | 29455-7125
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Country | US
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Telephone | 843-300-9626
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OF ORIENTAL MEDICINE
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Name | DR. MARY ELIZABETH WHITE KURYLA
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Credential | O.MD
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Telephone | 843-300-9626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number | 1913
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License Number State | SC
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