Individual
JACOB LEE HANSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
4216 MACCORKLE AVE SE STE 4, CHARLESTON, WV 25304-2539
(304) 926-0913
(304) 926-0914
Mailing address
4216 MACCORKLE AVE SE STE 4, CHARLESTON, WV 25304-2539
(304) 926-0913
(304) 926-0914
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT004694
WV
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/28/2019
Last updated
02/01/2024
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