Provider Demographics
NPI:1063175255
Name:PHENEY, ELIZABETH KATHRYN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATHRYN
Last Name:PHENEY
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 1:215 FERRYMAN LN
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8145
Mailing Address - Country:US
Mailing Address - Phone:314-753-2180
Mailing Address - Fax:
Practice Address - Street 1:215 FERRYMAN LN
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8145
Practice Address - Country:US
Practice Address - Phone:314-753-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist