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Individual

EMILY DEHAVEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
8543 WINCHESTER AVE, INWOOD, WV 25428-4022
(304) 229-1010
(304) 229-5151
Mailing address
8543 WINCHESTER AVE, INWOOD, WV 25428-4022
(304) 229-1010
(304) 229-5151

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002126
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PTA002126
PTA LICENSE
WV
Enumeration date
12/13/2021
Last updated
12/13/2021
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