Provider Demographics
NPI:1740379502
Name:WITHERSPOON, ANN KIRBY (PT)
Entity Type:Individual
Prefix:MISS
First Name:ANN
Middle Name:KIRBY
Last Name:WITHERSPOON
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 1:1485 SEMINOLE STREET
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7932
Mailing Address - Country:US
Mailing Address - Phone:843-849-1948
Mailing Address - Fax:
Practice Address - Street 1:570 LONG POINT ROAD
Practice Address - Street 2:SUITE 270 COASTAL THERAPEUTICS PA
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7932
Practice Address - Country:US
Practice Address - Phone:843-884-4783
Practice Address - Fax:843-884-4783
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist