Provider Demographics
NPI:1164140307
Name:DIBRDIGE, SAMUEL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:DIBRDIGE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CEDAR CIR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-1129
Mailing Address - Country:US
Mailing Address - Phone:864-350-8296
Mailing Address - Fax:
Practice Address - Street 1:3611 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7516
Practice Address - Country:US
Practice Address - Phone:864-350-8296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty