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General NPI Number Information
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NPI Number | 1922207380
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Entity Type | Individual
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Provider Name | PHILIP ALONZO DISCAYA PT
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Gender | Male
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 63 BLACKSTOCK RD
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City | INMAN
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State | SC
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Zip | 29349-1835
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Country | US
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Telephone | 864-472-9055
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Fax |
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Provider Business Mailing Address
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Address Line | 656 MOUNT VERNON LN
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City | DUNCAN
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State | SC
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Zip | 29334-8710
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Country | US
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Telephone | 864-486-8355
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 2620
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License Number State | SC
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