Provider Demographics
NPI:1831291475
Name:MURRAY, MISTY (LMT)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 THAMES VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2407
Mailing Address - Country:US
Mailing Address - Phone:803-269-6622
Mailing Address - Fax:
Practice Address - Street 1:10071 BROAD RIVER RD
Practice Address - Street 2:STE B
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2381
Practice Address - Country:US
Practice Address - Phone:803-445-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2005-1799225700000X
SC3637225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist