Provider Demographics
NPI:1114559192
Name:BENDZIEWICZ, STEPHEN (DPT, PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:BENDZIEWICZ
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BLACKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7838
Mailing Address - Country:US
Mailing Address - Phone:803-767-6361
Mailing Address - Fax:
Practice Address - Street 1:206 BLACKSTONE DR
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7838
Practice Address - Country:US
Practice Address - Phone:803-767-6361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT.101012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics