Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO04481 | WV |
N | 225200000X | Physical Therapy Assistant | PTA002315 | WV |
NPI | 1144747189 |
---|---|
Provider Name | Breanne Shrum |
First Address | Morgantown, WV 26505-2812 |
Second Address | Morgantown, WV 26505-2812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2017 |
Last Update Date | 29/08/2017 |