Individual
FRANK EDWARD IVAN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2650 S PLEASANT VALLEY RD, WINCHESTER, VA 22601-6518
(540) 228-1941
Mailing address
296 BIG TIMBER RD, CAPON BRIDGE, WV 26711-8943
(304) 860-5366
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
004477
WV
225100000X
Physical Therapist
Primary
2305206758
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2307001197
DIRECT ACCESS CERTIFICATION
VA
01
—
K949 - 0077
CAREFIRST
VA
Enumeration date
01/30/2011
Last updated
12/07/2024
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