Individual
MELISSA JANE STAVRAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, OCS
Contact information
Practice address
1605 GRAND CENTRAL AVE, VIENNA, WV 26105-1081
(304) 295-7290
(304) 295-5922
Mailing address
1605 GRAND CENTRAL AVE, VIENNA, WV 26105-1081
(304) 295-7290
(304) 295-5922
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002359
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2590290
—
OH
05
—
7301143000
—
WV
01
—
P00148738
RAILROAD MEDICARE
—
Enumeration date
07/31/2006
Last updated
05/24/2019
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