Provider Demographics
NPI:1255185955
Name:HANES, CIERA M (LMT)
Entity type:Individual
Prefix:
First Name:CIERA
Middle Name:M
Last Name:HANES
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 1:1833 FORT MOTTE RD
Mailing Address - Street 2:
Mailing Address - City:ST MATTHEWS
Mailing Address - State:SC
Mailing Address - Zip Code:29135-8821
Mailing Address - Country:US
Mailing Address - Phone:803-837-2465
Mailing Address - Fax:
Practice Address - Street 1:1797 HILLSBORO RD STE 6
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-3396
Practice Address - Country:US
Practice Address - Phone:803-837-2465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12814225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist