Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT002924 | WV |
NPI | 1003162918 |
---|---|
Provider Name | Miss Cynthia Jean Carr |
First Address | Comfort, WV 25049-0198 |
Second Address | South Charleston, WV 25309-2304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2012 |
Last Update Date | 29/07/2012 |