Provider Demographics
NPI:1922684901
Name:GUILLIAM, TORY R (DPT)
Entity Type:Individual
Prefix:
First Name:TORY
Middle Name:R
Last Name:GUILLIAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 OLD TROLLEY RD STE F
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5296
Mailing Address - Country:US
Mailing Address - Phone:843-486-0999
Mailing Address - Fax:843-486-0989
Practice Address - Street 1:1203 OLD TROLLEY RD STE F
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5296
Practice Address - Country:US
Practice Address - Phone:843-486-0999
Practice Address - Fax:843-486-0989
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist