Provider Demographics
NPI:1902320005
Name:VINSON, STEVEN BLAKE (DPT)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BLAKE
Last Name:VINSON
Suffix:
Gender:M
Credentials: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 3408
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-4015
Mailing Address - Country:US
Mailing Address - Phone:803-732-5887
Mailing Address - Fax:803-732-5997
Practice Address - Street 1:16 HYLAND RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5756
Practice Address - Country:US
Practice Address - Phone:864-627-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8723225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist