Provider Demographics
NPI:1346823903
Name:ABRAHAM, EDWARD CHARLES (LMT - SOUTH CAROLINA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:CHARLES
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:LMT - SOUTH CAROLINA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 VENDUE RANGE STE 204
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-2149
Mailing Address - Country:US
Mailing Address - Phone:404-964-7350
Mailing Address - Fax:
Practice Address - Street 1:32 VENDUE RANGE STE 204
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-2149
Practice Address - Country:US
Practice Address - Phone:404-964-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10517225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist