Provider Demographics
NPI:1346599867
Name:GASTON, LEE ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:ANN
Last Name:GASTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7580 CHARLOTTE HWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7801
Mailing Address - Country:US
Mailing Address - Phone:803-548-5662
Mailing Address - Fax:803-872-7029
Practice Address - Street 1:7580 CHARLOTTE HWY
Practice Address - Street 2:SUITE 500
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-7801
Practice Address - Country:US
Practice Address - Phone:803-548-5662
Practice Address - Fax:803-872-7029
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
SC2342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty