Basic Information
| Provider Information | |||||||||
| NPI: | 1922126481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCBRIDE | ||||||||
| FirstName: | DESIREE | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TAMBINI | ||||||||
| OtherFirstName: | DESIREE | ||||||||
| OtherMiddleName: | T | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1865 E. MAIN STREET | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DUNCAN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644861105 | ||||||||
| FaxNumber: | 8644861106 | ||||||||
| Practice Location | |||||||||
| Address1: | 535 LAURENS ROAD | ||||||||
| Address2: | |||||||||
| City: | WOODRUFF | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644766600 | ||||||||
| FaxNumber: | 8644763514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 05/15/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 004881 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | SC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.