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General NPI Number Information
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NPI Number | 1194458984
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Entity Type | Individual
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Provider Name | ELSA ANNE COLSTON LMT
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Gender | Female
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 129 MAIN ST
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City | BECKLEY
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State | WV
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Zip | 25801-4615
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Country | US
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Telephone | 304-719-9321
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Fax |
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Provider Business Mailing Address
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Address Line | 1009 1/2 2ND AVE
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City | MONTGOMERY
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State | WV
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Zip | 25136-2308
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Country | US
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Telephone | 304-719-9321
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2012-3069
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License Number State | WV
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