Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 0101045890 | VA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 29759 | WV |
NPI | 1013993047 |
---|---|
Provider Name | Deborah Thoren Mowery |
First Address | Daleville, VA 24083-2574 |
Second Address | Morgantown, WV 26505-3437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 24/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006800165 | (05) | VA |
1013993047 | (05) | VA |
216786 | ANTHEM (01) | |
250012231 | MC RAILROAD (01) | |
F62910 | (02) |