Healthcare Provider Details

I. General information

NPI: 1629131529
Provider Name (Legal Business Name): SANDRA DOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 U.S. ROUTE 60 EAST
HUNTINGTON WV
25705
US

IV. Provider business mailing address

31 CEDAR DR
HURRICANE WV
25526-9221
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-2200
  • Fax: 304-399-2201
Mailing address:
  • Phone: 304-757-0694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number241
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: