Provider Demographics
NPI:1275643504
Name:ZBYTOVSKY, CELISE M (PT)
Entity Type:Individual
Prefix:
First Name:CELISE
Middle Name:M
Last Name:ZBYTOVSKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CELISE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 HUNTER VILLAGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8345
Mailing Address - Country:US
Mailing Address - Phone:803-445-2941
Mailing Address - Fax:803-724-6830
Practice Address - Street 1:110 MEDICAL CIR STE B
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3642
Practice Address - Country:US
Practice Address - Phone:803-445-1009
Practice Address - Fax:803-445-1017
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist