Provider Demographics
NPI:1306333869
Name:WONSETTLER, CHARLES MARION
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MARION
Last Name:WONSETTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 WONSETTLER RD
Mailing Address - Street 2:
Mailing Address - City:SCENERY HILL
Mailing Address - State:PA
Mailing Address - Zip Code:15360-1831
Mailing Address - Country:US
Mailing Address - Phone:724-288-4997
Mailing Address - Fax:
Practice Address - Street 1:1160 VAN VOORHIS RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3437
Practice Address - Country:US
Practice Address - Phone:304-598-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology