Provider Demographics
NPI:1215114590
Name:DIGIOVANNA, VINCENT EARL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:EARL
Last Name:DIGIOVANNA
Suffix:
Gender:M
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:PO BOX 421718
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-4203
Mailing Address - Country:US
Mailing Address - Phone:843-652-8226
Mailing Address - Fax:
Practice Address - Street 1:2200 CROW LN STE 201
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1663
Practice Address - Country:US
Practice Address - Phone:843-848-5001
Practice Address - Fax:843-651-6575
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38606225100000X
WAPT60121015225100000X
AZ8269PT225100000X
IL070016392225100000X
NCP11211225100000X
VA2305205273225100000X
SC6859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist