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General NPI Number Information
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NPI Number | 1326695958
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Entity Type | Individual
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Provider Name | AERIAL ANN JARVIS DPT
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Gender | Female
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Dates
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Enumeration Date | 08/19/2019
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Last Update Date | 08/19/2019
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Provider Practice Location Address
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Address Line | 139 BAKER ST
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City | WEBSTER SPRINGS
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State | WV
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Zip | 26288-1192
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Country | US
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Telephone | 304-847-5608
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Fax |
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Provider Business Mailing Address
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Address Line | 73 BLAZE FORK RD
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City | WEBSTER SPRINGS
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State | WV
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Zip | 26288-9627
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Country | US
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Telephone | 304-644-1418
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT004194
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License Number State | WV
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