Individual
STACY RANAE CALLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, OCS
Contact information
Practice address
63 HOSPITALITY LN, SUITE 1, MINERAL WELLS, WV 26150-6704
(304) 489-8100
(304) 489-8191
Mailing address
1212 GARFIELD AVE, SUITE 200, PARKERSBURG, WV 26101-3247
(304) 865-6778
(304) 865-7400
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002524
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2702623
—
OH
05
—
3810007455
—
WV
01
—
P00352738
RAILROAD MEDICARE
—
Enumeration date
08/31/2006
Last updated
04/04/2012
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