MEDICARE: MARINNA PAIGE FLETCHER LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	00390	WV

General Provider Information

NPI Number	:	1518201177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINNA PAIGE FLETCHER LPTA

Provider Business Mailing Address
First Line	:	501 CALDWELL LN
Second Line	:
City	:	DUNBAR
State	:	WV
Zip	:	25064-2026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 CALDWELL LN
Second Line	:
City	:	DUNBAR
State	:	WV
Zip	:	25064-2026
Country	:	US
Telephone Number	:	304-549-9082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	11/20/2012

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