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NPI Code Detail

MEDICARE: SAMANTHA C ELSWICK PTA

MEDICARE: SAMANTHA C ELSWICK PTA
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
1225200000XPhysical Therapy Assistant000802WV

General Provider Information

NPI Number : 1952427239
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA C ELSWICK PTA
Provider Business Mailing Address
First Line : RR 1 BOX 260D
Second Line :
City : FAYETTEVILLE
State : WV
Zip : 25840-9723
Country : US
Telephone Number : 304-465-0624
Fax Number :
Provider Business Practice Location Address
First Line : 422 23RD ST
Second Line :
City : OAK HILL
State : WV
Zip : 25901-2830
Country : US
Telephone Number : 304-465-1903
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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Directions to “ SAMANTHA C ELSWICK PTA” Practice Location

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