Individual
MRS. M A ZURITA HERNANDO IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
240 WASHINGTON STREET, RAVENSWOOD, WV 26164
(304) 273-8071
(304) 273-8015
Mailing address
240 WASHINGTON STREET, PO BOX 536, RAVENSWOOD, WV 26164
(304) 273-8071
(304) 273-8015
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
001137
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0157410000
—
WV
05
—
0240071000
—
WV
Enumeration date
12/14/2006
Last updated
12/17/2007
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