Provider Demographics
NPI:1205101870
Name:DRIGGERS, PRISCILLA (PTA)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:DRIGGERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 LAZY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-7817
Mailing Address - Country:US
Mailing Address - Phone:843-761-6795
Mailing Address - Fax:
Practice Address - Street 1:5213 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8783
Practice Address - Country:US
Practice Address - Phone:843-761-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1618225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant