Provider Demographics
NPI:1437109592
Name:COULTER, VIRGINIA MANNING (PT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MANNING
Last Name:COULTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 BROAD STREET ; PMB 352
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150
Mailing Address - Country:US
Mailing Address - Phone:803-469-3213
Mailing Address - Fax:803-469-3233
Practice Address - Street 1:540 BULTMAN DR STE 3
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2592
Practice Address - Country:US
Practice Address - Phone:803-883-6876
Practice Address - Fax:803-335-5394
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist