Individual
LISA R ROLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3875 ROBERT C BYRD DR, BECKLEY, WV 25801
(304) 253-1960
(304) 253-3080
Mailing address
PO BOX 1324, SOPHIA, WV 25921-1324
(304) 683-9741
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
001053
WV
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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