Healthcare Provider Details

I. General information

NPI: 1255826368
Provider Name (Legal Business Name): DARLA SUE NIGHTINGALE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2018
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 LEE ROAD
FOLLANSBEE WV
26037
US

IV. Provider business mailing address

20143 16 SCHOOL RD
WELLSVILLE OH
43968-9615
US

V. Phone/Fax

Practice location:
  • Phone: 304-527-1100
  • Fax:
Mailing address:
  • Phone: 330-853-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001929
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number09059
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: