Individual
KEVIN A WORKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT/ATC
Contact information
Practice address
111 DAVIS STUART ROAD, RONCEVERTE, WV 24970
(304) 647-3987
(304) 647-3990
Mailing address
111 DAVIS STUART ROAD, RONCEVERTE, WV 24970
(304) 647-3987
(304) 647-3990
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
001069
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000159932
BCBS
WV
05
—
0156783000
—
WV
01
—
550755833
WV WORKERS COMP
WV
Enumeration date
10/31/2006
Last updated
07/09/2007
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