Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology |
NPI | 1306333869 |
---|---|
Provider Name | Charles Marion Wonsettler |
First Address | Scenery Hill, PA 15360-1831 |
Second Address | Morgantown, WV 26505-3437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2018 |
Last Update Date | 19/04/2018 |