Provider Demographics
NPI:1295771004
Name:SPRINGS, MARYDITH (PT)
Entity type:Individual
Prefix:MRS
First Name:MARYDITH
Middle Name:
Last Name:SPRINGS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730B SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6255
Mailing Address - Country:US
Mailing Address - Phone:843-763-4115
Mailing Address - Fax:843-766-3240
Practice Address - Street 1:110 HIGHLAND CENTER DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9247
Practice Address - Country:US
Practice Address - Phone:803-408-3277
Practice Address - Fax:803-408-3299
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1535Medicaid