Provider Demographics
NPI:1023585650
Name:WITHERSPOON, APRIL DIAMOND (PT, DPT)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:DIAMOND
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 DRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:SALTERS
Mailing Address - State:SC
Mailing Address - Zip Code:29590-3727
Mailing Address - Country:US
Mailing Address - Phone:843-356-2790
Mailing Address - Fax:
Practice Address - Street 1:965 E YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5938
Practice Address - Country:US
Practice Address - Phone:843-356-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist