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General NPI Number Information
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NPI Number | 1386160497
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Entity Type | Organization
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Legal Business Name | STATS AND STRIDES THERAPEUTIC EQUINE CENTER
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 08/21/2017
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Provider Practice Location Address
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Address Line | 519 NEW QUARTER RD
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City | MEADOWBROOK
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State | WV
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Zip | 26404
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Country | US
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Telephone | 304-677-8130
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Fax |
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Provider Business Mailing Address
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Address Line | 105 STEELE ST # 48
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1068
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Country | US
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Telephone | 304-677-8130
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | REBECCA FLANAGAN
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Credential |
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Telephone | 304-677-8130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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