Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1079 | WV |
NPI | 1013142579 |
---|---|
Provider Name | Bart Elkins |
First Address | Marmet, WV 25315-1977 |
Second Address | Marmet, WV 25315-1977 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2009 |
Last Update Date | 27/05/2009 |