Provider Demographics
NPI:1053723577
Name:IMBEAU, NANCY KANA (PT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:KANA
Last Name:IMBEAU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:KANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6526
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29260-6526
Mailing Address - Country:US
Mailing Address - Phone:803-693-5040
Mailing Address - Fax:803-993-9472
Practice Address - Street 1:4420 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2629
Practice Address - Country:US
Practice Address - Phone:803-233-1366
Practice Address - Fax:803-233-1367
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist