Basic Information
| Provider Information | |||||||||
| NPI: | 1285742015 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUMBIE | ||||||||
| FirstName: | HEATHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 GASSAWAY ST | ||||||||
| Address2: | |||||||||
| City: | CENTRAL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296308817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196041112 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12023 N RADIO STATION RD | ||||||||
| Address2: | STE A | ||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296781143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8649850770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 05/01/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 6404 | 01 | NC | LICENSE # | OTHER | 3714 | 01 | SC | SC PT LICENSE | OTHER |