Provider Demographics
NPI:1740866334
Name:ELLIOTT, KEANDRIA R (DPT)
Entity type:Individual
Prefix:DR
First Name:KEANDRIA
Middle Name:R
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 E LIBERTY SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:CROSS HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29332-3723
Mailing Address - Country:US
Mailing Address - Phone:864-554-9200
Mailing Address - Fax:
Practice Address - Street 1:344 VIEW DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7252
Practice Address - Country:US
Practice Address - Phone:803-400-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
SC10566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist