Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1056 | WV |
NPI | 1003038035 |
---|---|
Provider Name | Mrs. Christi Anne Captain |
First Address | Huntington, WV 25701-3120 |
Second Address | Huntington, WV 25701-9448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 15/10/2014 |