Healthcare Provider Details

I. General information

NPI: 1871611954
Provider Name (Legal Business Name): RAFAEL F. RAMIREZ DE ARELLANO RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 500
MARLINTON WV
24954-9754
US

IV. Provider business mailing address

PO BOX 104
SLATYFORK WV
26291-0104
US

V. Phone/Fax

Practice location:
  • Phone: 304-799-7375
  • Fax:
Mailing address:
  • Phone: 304-572-4378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001478
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: