Active NPI
Tayvionna Etheredge
- Physical Medicine & Rehabilitation Physician
- West Columbia, SC
National Provider Identifier
1316633753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- PTA.5096
- Practice address
- 100 Dreher Road
Suite 100
West Columbia, SC 29169 - Phone
- (803) 525-7080
- NPI assigned
- Apr 17, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | PTA.5096 | SC | Primary |
Addresses
Primary practice location
100 Dreher Road
Suite 100
West Columbia, SC 29169
Mailing address
100 Dreher Road
Suite 100
West Columbia, SC 29169
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA.5096 | SC | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681689600000",
"number": "1316633753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 DREHER ROAD",
"address_2": "SUITE 100",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "29169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 DREHER ROAD",
"address_2": "SUITE 100",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "29169",
"telephone_number": "803-525-7080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETHEREDGE",
"first_name": "TAYVIONNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-17",
"last_updated": "2023-04-17",
"certification_date": "2023-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "SC",
"license": "PTA.5096",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.