Healthcare Provider Details

I. General information

NPI: 1770247421
Provider Name (Legal Business Name): HANNAH PAIGE STAATS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S RITCHIE AVE
RAVENSWOOD WV
26164-1721
US

IV. Provider business mailing address

79 MANDOLIN DR
SANDYVILLE WV
25275-9629
US

V. Phone/Fax

Practice location:
  • Phone: 304-273-9385
  • Fax:
Mailing address:
  • Phone: 304-532-8941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number002798
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: