Individual
GOBEL E MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, PTA, ATC
Contact information
Practice address
943 MAPLE DR, MORGANTOWN, WV 26505-2812
(304) 599-2515
Mailing address
943 MAPLE DR, MORGANTOWN, WV 26505-2812
(304) 599-2515
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 001823
WV
2255A2300X
Athletic Trainer
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070702738
BOC CERTIFICATION
—
01
—
PTA 001823
PHYSICAL THERAPIST ASSISTANT
WV
Enumeration date
05/07/2010
Last updated
03/27/2013
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