Provider Demographics
NPI:1356340699
Name:HITE, STEPHANIE A (PT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:HITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEHPHANIE
Other - Middle Name:A
Other - Last Name:VIGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 N BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3253
Mailing Address - Country:US
Mailing Address - Phone:803-433-9001
Mailing Address - Fax:803-433-9002
Practice Address - Street 1:122 N BROOKS ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3253
Practice Address - Country:US
Practice Address - Phone:803-433-9001
Practice Address - Fax:803-433-9002
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ33153Medicare UPIN
SC8524Medicare PIN