Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 002874 | WV |
NPI | 1003123878 |
---|---|
Provider Name | Mrs. Lawren Elizabeth Sandy |
First Address | Bridgeport, WV 26330-1751 |
Second Address | Bridgeport, WV 26330-1751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2010 |
Last Update Date | 01/09/2010 |