Individual
LISA ANN WAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1109 JEFFERSON RD, S CHARLESTON, WV 25309-9780
(304) 610-7888
Mailing address
2939 SHADYSIDE RD, ST ALBANS, WV 25177
(304) 610-7888
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
0388
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0388
LICENSE
WV
Enumeration date
06/26/2007
Last updated
07/08/2007
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