Healthcare Provider Details

I. General information

NPI: 1104376318
Provider Name (Legal Business Name): JOANNA CECIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 LEE RD
FOLLANSBEE WV
26037-1783
US

IV. Provider business mailing address

1517 ROLLING ACRES RD
NEW CUMBERLAND WV
26047-3040
US

V. Phone/Fax

Practice location:
  • Phone: 304-527-1100
  • Fax:
Mailing address:
  • Phone: 386-986-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 000839
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: