Provider Demographics
NPI:1780857391
Name:PADGETT, PAUL LEE (PT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LEE
Last Name:PADGETT
Suffix:
Gender:M
Credentials:PT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29054-0615
Mailing Address - Country:US
Mailing Address - Phone:803-892-0315
Mailing Address - Fax:
Practice Address - Street 1:125 STATE ST BLDG 3
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-7557
Practice Address - Country:US
Practice Address - Phone:803-973-0808
Practice Address - Fax:803-973-5053
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist