MEDICARE: HEATHER DAWN HOUSEL

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	002369	WV

General Provider Information

NPI Number	:	1891446704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER DAWN HOUSEL

Provider Business Mailing Address
First Line	:	302 S CHELSEA ST
Second Line	:
City	:	SISTERSVILLE
State	:	WV
Zip	:	26175-1004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 SUNBRIDGE DR
Second Line	:
City	:	SALEM
State	:	WV
Zip	:	26426-8400
Country	:	US
Telephone Number	:	304-782-3000
Fax Number	:

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

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	01/12/2022

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Directions to “ HEATHER DAWN HOUSEL ” Practice Location

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