Individual
CHAD FAZENBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
260 SUNRISE BLVD, ROMNEY, WV 26757-6345
(304) 822-7527
Mailing address
170 W MECHANIC ST, FROSTBURG, MD 21532-1541
(301) 697-1572
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002565
WV
Other
Enumeration date
09/27/2020
Last updated
09/27/2020
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