Healthcare Provider Details

I. General information

NPI: 1013064104
Provider Name (Legal Business Name): AMANDA S STUCHELL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 7 VALLEY PLAZA
REEDSVILLE WV
26547
US

IV. Provider business mailing address

300 S PRICE ST
KINGWOOD WV
26537-1442
US

V. Phone/Fax

Practice location:
  • Phone: 304-864-3777
  • Fax: 304-864-6323
Mailing address:
  • Phone: 304-329-1400
  • Fax: 304-329-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002334
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: