Provider Demographics
NPI:1376239657
Name:DERISI, SHEILA (LPTA)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:DERISI
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 HAWKSMOOR DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-1140
Mailing Address - Country:US
Mailing Address - Phone:860-718-5226
Mailing Address - Fax:
Practice Address - Street 1:9547 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4005
Practice Address - Country:US
Practice Address - Phone:877-787-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant