| NPI | 1821365339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA C DAVIS Owner 304-916-1894 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WV 1380) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT001341) |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2012-02-06 |