Healthcare Provider Details

I. General information

NPI: 1548278880
Provider Name (Legal Business Name): DAVID TOWNSEND TOLEMAN RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 PANAMA STREET
HARPERS FERRY WV
25425
US

IV. Provider business mailing address

3511 CEMETERY CIR
KNOXVILLE MD
21758-9642
US

V. Phone/Fax

Practice location:
  • Phone: 304-535-2400
  • Fax: 304-535-2424
Mailing address:
  • Phone: 301-834-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2293
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: