Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 003060 | WV |
N | 2251N0400X | Physical Therapist - Neurology | 003060 | WV |
NPI | 1578044244 |
---|---|
Provider Name | Laura Stephens |
First Address | Huntington, WV 25702-1435 |
Second Address | Charleston, WV 25304-2503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2018 |
Last Update Date | 22/08/2018 |