Provider Demographics
NPI:1922833235
Name:FENTON, ELIZABETH FAITH (DPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FAITH
Last Name:FENTON
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 1:3040 N HIGHWAY 17 STE A
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9438
Mailing Address - Country:US
Mailing Address - Phone:843-388-7667
Mailing Address - Fax:843-388-7877
Practice Address - Street 1:3040 N HIGHWAY 17 STE A
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-9438
Practice Address - Country:US
Practice Address - Phone:843-388-7667
Practice Address - Fax:843-388-7877
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCP033233T225100000X
NJ40QA02268000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist