Provider Demographics
NPI:1508299702
Name:CARMICHAEL, HERBERT VICTOR III (PT)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:VICTOR
Last Name:CARMICHAEL
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PRATHER PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7910
Mailing Address - Country:US
Mailing Address - Phone:843-742-5701
Mailing Address - Fax:843-742-5704
Practice Address - Street 1:100 PRATHER PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7910
Practice Address - Country:US
Practice Address - Phone:843-742-5701
Practice Address - Fax:843-742-5704
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist