Individual
IVAN LUKE WEST SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
175 CIDER RUN, MAGNOLIA, DE 19962-1667
(302) 233-8622
Mailing address
175 CIDER RUN, MAGNOLIA, DE 19962-1667
(302) 233-8622
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
J2-0000771
DE
Other
Enumeration date
10/01/2014
Last updated
10/01/2014
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