Provider Demographics
NPI:1023467479
Name:EIKEVIK, MARIESA (DPT)
Entity type:Individual
Prefix:MRS
First Name:MARIESA
Middle Name:
Last Name:EIKEVIK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3559 FRANKLIN TOWER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9383
Mailing Address - Country:US
Mailing Address - Phone:571-244-7206
Mailing Address - Fax:854-227-5165
Practice Address - Street 1:3559 FRANKLIN TOWER DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466
Practice Address - Country:US
Practice Address - Phone:571-244-7206
Practice Address - Fax:854-227-5165
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist