Healthcare Provider Details

I. General information

NPI: 1427067362
Provider Name (Legal Business Name): SHERRY L RATLIFF L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 IOWA ST
GASSAWAY WV
26624-1235
US

IV. Provider business mailing address

206 ELK ST
GASSAWAY WV
26624-1420
US

V. Phone/Fax

Practice location:
  • Phone: 304-364-8521
  • Fax: 304-364-8406
Mailing address:
  • Phone: 304-364-8097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2003-1229
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: