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General NPI Number Information
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NPI Number | 1063634103
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Entity Type | Individual
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Provider Name | MARIANNA LE SEXTON MPT
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 BRADLEY FOSTER DR
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City | HUNTINGTON
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State | WV
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Zip | 25701-9448
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Country | US
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Telephone | 304-525-3561
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Fax | 304-525-3561
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Provider Business Mailing Address
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Address Line | 140 TOWNSHIP ROAD 1216
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City | PROCTORVILLE
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State | OH
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Zip | 45669-8644
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Country | US
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Telephone | 740-886-0858
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Fax | 740-886-7854
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2150
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License Number State | WV
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