Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 874 | WV |
NPI | 1013251578 |
---|---|
Provider Name | Bridgette Ellen Crumrine |
First Address | New Martinsville, WV 26155-2109 |
Second Address | New Martinsville, WV 26155-1572 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2012 |
Last Update Date | 21/11/2012 |