Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | ||
Y | 2251X0800X | Physical Therapist - Orthopedic | 002422 | WV |
NPI | 1003462250 |
---|---|
Provider Name | Scott Smolder |
First Address | Winfield, WV 25213-8616 |
Second Address | Charleston, WV 25311-1280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2019 |
Last Update Date | 14/08/2019 |