Individual provider · NPI-1
Deealice Moton, LMT
Rehabilitation Practitioner · Aiken, SC
NPI number1477826071
StatusActive
Last updated in NPPESJan 9, 2025
Details
- NPI
- 1477826071
- Entity type
- Individual (NPI-1)
- Name
- Deealice Moton
- Credential
- LMT
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Feb 14, 2012
- Certification date
- Jan 9, 2025
- Last updated
- Jan 9, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225400000X | Rehabilitation Practitioner | 9071 | SC | Yes |
| 171000000X | Military Health Care Provider | 9071 | SC | |
| 208100000X | Physical Medicine & Rehabilitation | Mas.9071 | SC | |
| 2081P2900X | Physical Medicine & Rehabilitation, Pain Medicine | 9071 | SC | |
| 208VP0014X | Pain Medicine, Interventional Pain Medicine | 9071 | SC | |
| 225700000X | Massage Therapist | MT007357 | GA |
Practice location
6350 Woodside Executive CtAiken, SC 29803-3825
Phone 706-951-5812
Mailing address
6240 Woodside Executive CtAiken, SC 29803-3822
Phone 706-627-6005 · Fax 888-807-5411
Other practice locations
5150 Woodside Executive Ct
Aiken, SC 29803-3814
Aiken, SC 29803-3814
Phone 706-627-6005 · Fax 888-807-5411
6240 Woodside Executive Ct
Aiken, SC 29803-3822
Aiken, SC 29803-3822
Phone 803-226-0089
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