| NPI | 1619241825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA STEPHENSON Lmt 304-431-3535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 002466) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WV 20102705) |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2012-03-06 |