Provider Demographics
NPI:1285750406
Name:SPAULDING, DENISE MICHELLE (PTA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 CIRCLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-9329
Mailing Address - Country:US
Mailing Address - Phone:304-256-7379
Mailing Address - Fax:
Practice Address - Street 1:125 SADDLESHOP RD.
Practice Address - Street 2:
Practice Address - City:HILLTOP
Practice Address - State:WV
Practice Address - Zip Code:25855-0125
Practice Address - Country:US
Practice Address - Phone:304-469-2966
Practice Address - Fax:304-469-2674
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000721225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant