Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 004162 | WV |
NPI | 1285399931 |
---|---|
Provider Name | Millicent Roscenne Atienza Mauleon |
First Address | Buckhannon, WV 26201-1242 |
Second Address | Buckhannon, WV 26201-2909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2021 |
Last Update Date | 07/11/2021 |