Provider Demographics
NPI:1144208372
Name:SUTHARD, PAULA SLOVER (PT)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:SLOVER
Last Name:SUTHARD
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 1:108 WEATHERBY CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7639
Mailing Address - Country:US
Mailing Address - Phone:803-315-1602
Mailing Address - Fax:803-808-1141
Practice Address - Street 1:108 WEATHERBY CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7639
Practice Address - Country:US
Practice Address - Phone:803-315-1602
Practice Address - Fax:803-808-1141
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTHO726Medicaid