Provider Demographics
NPI:1518581057
Name:LOUDERMILK, EMILY RENAE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RENAE
Last Name:LOUDERMILK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MITCHELL RD APT G2
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2659
Mailing Address - Country:US
Mailing Address - Phone:864-314-6720
Mailing Address - Fax:
Practice Address - Street 1:1305 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4139
Practice Address - Country:US
Practice Address - Phone:864-458-7566
Practice Address - Fax:864-288-8043
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4318225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant