Healthcare Provider Details

I. General information

NPI: 1558584573
Provider Name (Legal Business Name): JAMES A POWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 N PLEASANTS HWY
SAINT MARYS WV
26170-8511
US

IV. Provider business mailing address

1851 N PLEASANTS HWY
SAINT MARYS WV
26170-8511
US

V. Phone/Fax

Practice location:
  • Phone: 304-684-2248
  • Fax: 304-684-2250
Mailing address:
  • Phone: 304-684-2248
  • Fax: 304-684-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number000582
License Number StateWV

VIII. Authorized Official

Name: JAMES A POWELL
Title or Position: OWNER
Credential: PT
Phone: 304-684-2248