Individual
MRS. DONNA MARIE GORTON-CHILDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 766-3589
(304) 766-3793
Mailing address
1904 WOODSIDE CIR, CHARLESTON, WV 25314-2256
(304) 346-0703
(304) 766-3793
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
4086
MA
225100000X
Physical Therapist
Primary
446
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
257882
MAMSI
WV
Enumeration date
05/03/2007
Last updated
03/10/2010
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