Provider Demographics
NPI:1669543021
Name:NESBITT, DAVID BRIAN (PTA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRIAN
Last Name:NESBITT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FOXBERRY CT
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2072
Mailing Address - Country:US
Mailing Address - Phone:843-437-2211
Mailing Address - Fax:
Practice Address - Street 1:119 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2407
Practice Address - Country:US
Practice Address - Phone:803-536-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2010225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant