Provider Demographics
NPI:1144931767
Name:LEPPER, MAVIS (DPT)
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:LEPPER
Suffix:
Gender:F
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 629
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-0629
Mailing Address - Country:US
Mailing Address - Phone:843-671-7342
Mailing Address - Fax:843-671-7343
Practice Address - Street 1:8 HOSPITAL CENTER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-8702
Practice Address - Country:US
Practice Address - Phone:843-671-7342
Practice Address - Fax:843-671-7343
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist