Provider Demographics
NPI:1881341246
Name:CONYERS, WHITNEY
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:CONYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:SC
Mailing Address - Zip Code:29069-9162
Mailing Address - Country:US
Mailing Address - Phone:843-610-2509
Mailing Address - Fax:
Practice Address - Street 1:2825 CARTER RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1712
Practice Address - Country:US
Practice Address - Phone:803-469-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4778225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant