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General NPI Number Information
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NPI Number | 1730695255
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Entity Type | Individual
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Provider Name | ADRICK DORELL CEASAR PT
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Gender | Male
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 03/30/2024
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Provider Practice Location Address
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Address Line | 226 LAKE FAIRFIELD DR
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City | GREENVILLE
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State | SC
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Zip | 29615-1548
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Country | US
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Telephone | 864-881-2002
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Fax |
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Provider Business Mailing Address
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Address Line | 511 GRIMES DR
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-6372
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Country | US
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Telephone |
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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 | 8756
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License Number State | SC
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