Provider Demographics
NPI:1619849114
Name:CHEDEBEAUX, ROSARIO
Entity type:Individual
Prefix:
First Name:ROSARIO
Middle Name:
Last Name:CHEDEBEAUX
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 1:3799 12TH STREET EXT STE 100
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3750
Mailing Address - Country:US
Mailing Address - Phone:803-926-6810
Mailing Address - Fax:
Practice Address - Street 1:3799 12TH STREET EXT STE 100
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-3750
Practice Address - Country:US
Practice Address - Phone:803-926-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist