Provider Demographics
NPI:1760599427
Name:LAWRIMORE, STACEY E (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:E
Last Name:LAWRIMORE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MRS
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:401 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HEMINGWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29554-9191
Mailing Address - Country:US
Mailing Address - Phone:843-558-4830
Mailing Address - Fax:843-558-7752
Practice Address - Street 1:401 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:HEMINGWAY
Practice Address - State:SC
Practice Address - Zip Code:29554-9191
Practice Address - Country:US
Practice Address - Phone:843-558-4830
Practice Address - Fax:843-558-7752
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0363Medicaid