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General NPI Number Information
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NPI Number | 1871859470
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Entity Type | Individual
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Provider Name | JOANN TYMESON MPT
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Gender | Female
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 200 HIGH ST
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City | GLENVILLE
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State | WV
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Zip | 26351-1200
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Country | US
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Telephone | 304-462-8933
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Fax | 304-462-8934
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Provider Business Mailing Address
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Address Line | 155 RESTON PL
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City | GASSAWAY
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State | WV
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Zip | 26624-9356
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Country | US
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Telephone | 304-364-9191
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Fax | 304-364-9193
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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 | 001496
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License Number State | WV
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