Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 002241 | WV |
NPI | 1013406727 |
---|---|
Provider Name | Mrs. Alison Jane Bragg |
First Address | Buckhannon, WV 26201-4698 |
Second Address | Buckhannon, WV 26201-4698 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2018 |
Last Update Date | 08/05/2018 |