Provider Demographics
NPI:1124639208
Name:BINDER, LYDIA GRACE (ATC)
Entity type:Individual
Prefix:MISS
First Name:LYDIA
Middle Name:GRACE
Last Name:BINDER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:TIGERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29688-0216
Mailing Address - Country:US
Mailing Address - Phone:864-907-7590
Mailing Address - Fax:
Practice Address - Street 1:7801 N TIGERVILLE RD
Practice Address - Street 2:
Practice Address - City:TIGERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29688-9700
Practice Address - Country:US
Practice Address - Phone:864-907-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC5076862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty