Healthcare Provider Details

I. General information

NPI: 1972945574
Provider Name (Legal Business Name): JOCELYN BOND MA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19771 COAL HERITAGE RD
WELCH WV
24801
US

IV. Provider business mailing address

215 MEADOWS AVE
CRAB ORCHARD WV
25827-9532
US

V. Phone/Fax

Practice location:
  • Phone: 304-682-7100
  • Fax: 304-682-7400
Mailing address:
  • Phone: 304-575-6874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 002830
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: