Provider Demographics
NPI:1053778282
Name:WITHERSPOON EDWARDS, STEPHENI (DPT)
Entity type:Individual
Prefix:
First Name:STEPHENI
Middle Name:
Last Name:WITHERSPOON EDWARDS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STEPHENI
Other - Middle Name:
Other - Last Name:WITHERSPOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:297 W BOYCE ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3004
Mailing Address - Country:US
Mailing Address - Phone:803-968-6262
Mailing Address - Fax:
Practice Address - Street 1:297 W BOYCE ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3004
Practice Address - Country:US
Practice Address - Phone:803-433-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist