Provider Demographics
NPI:1750566360
Name:WEST, CHARMIN WHETSELL (PT)
Entity type:Individual
Prefix:MRS
First Name:CHARMIN
Middle Name:WHETSELL
Last Name:WEST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29018-0582
Mailing Address - Country:US
Mailing Address - Phone:803-829-3278
Mailing Address - Fax:803-395-2097
Practice Address - Street 1:3000 ST MATTHEWS RD
Practice Address - Street 2:REGIONAL MEDICAL CENTER
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118
Practice Address - Country:US
Practice Address - Phone:803-395-2090
Practice Address - Fax:803-395-2097
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC216535Medicaid
SC420068Medicare PIN