Healthcare Provider Details

I. General information

NPI: 1063549533
Provider Name (Legal Business Name): PATRICIA FRIEND LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 SAND ST
RAVENSWOOD WV
26164-1627
US

IV. Provider business mailing address

762 SKULL RUN
MURRAYSVILLE WV
26164-8738
US

V. Phone/Fax

Practice location:
  • Phone: 304-273-5585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2003-1153
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: