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General NPI Number Information
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NPI Number | 1225158629
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Entity Type | Individual
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Provider Name | MARY ANNE DUTTON
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 3201 GRAND CENTRAL AVE
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City | VIENNA
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State | WV
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Zip | 26105-1539
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Country | US
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Telephone | 304-295-9594
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Fax |
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Provider Business Mailing Address
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Address Line | 4701 6TH AVE
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City | VIENNA
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State | WV
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Zip | 26105-3003
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Country | US
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Telephone | 304-295-8371
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 001017
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License Number State | WV
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