Healthcare Provider Details

I. General information

NPI: 1063634103
Provider Name (Legal Business Name): MARIANNA LE SEXTON MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRADLEY FOSTER DR
HUNTINGTON WV
25701-9448
US

IV. Provider business mailing address

140 TOWNSHIP ROAD 1216
PROCTORVILLE OH
45669-8644
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-3561
  • Fax: 304-525-3561
Mailing address:
  • Phone: 740-886-0858
  • Fax: 740-886-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2150
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: