Provider Demographics
NPI:1730695255
Name:CEASAR, ADRICK DORELL (PT)
Entity type:Individual
Prefix:
First Name:ADRICK
Middle Name:DORELL
Last Name:CEASAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:ADRICK
Other - Middle Name:DORELL
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:511 GRIMES DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:226 LAKE FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1548
Practice Address - Country:US
Practice Address - Phone:864-881-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist