Provider Demographics
NPI:1912313495
Name:LOUDERMILK, JESSICA (PT DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LOUDERMILK
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WILLIAM POPE DR
Mailing Address - Street 2:STE 3
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7550
Mailing Address - Country:US
Mailing Address - Phone:864-654-2001
Mailing Address - Fax:800-305-7112
Practice Address - Street 1:501 FOREST LN
Practice Address - Street 2:SUITE A
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2621
Practice Address - Country:US
Practice Address - Phone:864-654-2001
Practice Address - Fax:800-305-7112
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist