Provider Demographics
NPI:1083500961
Name:TOBIAS, KACIE MADISON (DPT)
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:MADISON
Last Name:TOBIAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 WACHESAW DR # 7-305
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-6410
Mailing Address - Country:US
Mailing Address - Phone:864-205-7604
Mailing Address - Fax:
Practice Address - Street 1:305 WACHESAW DR # 7-305
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-6410
Practice Address - Country:US
Practice Address - Phone:864-205-7604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC128992251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics