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General NPI Number Information
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NPI Number | 1730485376
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Entity Type | Individual
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Provider Name | FRANK EDWARD IVAN III P.T.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2011
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 2650 S PLEASANT VALLEY RD
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City | WINCHESTER
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State | VA
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Zip | 22601-6518
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Country | US
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Telephone | 540-228-1941
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Fax |
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Provider Business Mailing Address
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Address Line | 296 BIG TIMBER RD
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City | CAPON BRIDGE
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State | WV
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Zip | 26711-8943
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Country | US
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Telephone | 304-860-5366
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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 | 004477
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305206758
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License Number State | VA
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