Individual
MR. JEREMY ROBERT STUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
54 W 3RD AVE, WILLIAMSON, WV 25661-3508
(304) 235-4300
(304) 235-0176
Mailing address
59 RUSS ST, UNIONTOWN, PA 15401-8934
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002281
WV
225100000X
Physical Therapist
PT015972
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810000550
—
WV
01
—
571136141003
BLUE CROSS/BLUE SHIELD
WV
Enumeration date
07/25/2006
Last updated
07/08/2007
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