Provider Demographics
NPI:1023465598
Name:SPURGEON, MIRANDA HILDRED (LMT)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:HILDRED
Last Name:SPURGEON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 HANSFORD DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3626
Mailing Address - Country:US
Mailing Address - Phone:843-345-1126
Mailing Address - Fax:
Practice Address - Street 1:527 HANSFORD DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3626
Practice Address - Country:US
Practice Address - Phone:843-345-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6478225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist