Provider Demographics
NPI:1982140976
Name:CROMWELL, MARIANNE (PT,DPT)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:CROMWELL
Suffix:
Gender:F
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 1:588 OLD MOUNT HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2814
Mailing Address - Country:US
Mailing Address - Phone:843-376-5595
Mailing Address - Fax:
Practice Address - Street 1:588 OLD MOUNT HOLLY RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2814
Practice Address - Country:US
Practice Address - Phone:843-376-5595
Practice Address - Fax:843-797-7432
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP2923225100000X
SCSC5964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist