Provider Demographics
NPI:1922126481
Name:MCBRIDE, DESIREE T (PT)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:T
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:T
Other - Last Name:TAMBINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1865 E. MAIN STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334
Mailing Address - Country:US
Mailing Address - Phone:864-486-1105
Mailing Address - Fax:864-486-1106
Practice Address - Street 1:535 LAURENS ROAD
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388
Practice Address - Country:US
Practice Address - Phone:864-476-6600
Practice Address - Fax:864-476-3514
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004881225100000X
SC225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6981Medicare UPIN
346554Medicare Oscar/Certification