| NPI | 1750657664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY E HICKMAN President 304-366-8395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: WV 1046-0165) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: WV 1046-0165) |
| Enumeration Date | 2012-03-25 |
| Last Update Date | 2012-03-25 |