Provider Demographics
NPI:1659706125
Name:CREECH, MARILYN MCMILLAN (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:MCMILLAN
Last Name:CREECH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 PAULS PATH RD
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-6732
Mailing Address - Country:US
Mailing Address - Phone:843-464-0264
Mailing Address - Fax:
Practice Address - Street 1:6002 PAULS PATH RD
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-6732
Practice Address - Country:US
Practice Address - Phone:843-464-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist