Basic Information
| Provider Information | |||||||||
| NPI: | 1831508480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMERDJIAN | ||||||||
| FirstName: | DANIELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1004 10TH ST | ||||||||
| Address2: | |||||||||
| City: | PORT ROYAL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299352310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433109689 | ||||||||
| FaxNumber: | 8003179690 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 HOSPITAL CENTER BLVD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299268700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436717342 | ||||||||
| FaxNumber: | 8436717343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2014 | ||||||||
| LastUpdateDate: | 03/31/2019 | ||||||||
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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 | PT .7464 PT | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.