Stacy Ranae Callow, DPT, OCS
Individual provider Active NPI Physical Therapist · Mineral Wells, WV
NPI 1023129129 · NPPES record last updated Apr 4, 2012
Key facts
- NPI
- 1023129129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 002524 (WV)
- Practice address
- 63 Hospitality LN
Suite 1
Mineral Wells, WV 26150-6704 - Phone
- (304) 489-8100
- Fax
- (304) 489-8191
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002524 | WV | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 002524 | WV | Yes |
Addresses
Primary practice location
63 Hospitality LN
Suite 1
Mineral Wells, WV 26150-6704
Mailing address
1212 Garfield Ave
Suite 200
Parkersburg, WV 26101-3247
Phone (304) 865-6778
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810007455 | Medicaid | WV | |
| 2702623 | Medicaid | OH | |
| P00352738 | Other | RAILROAD MEDICARE |
Other names
- Stacy Ranae Buchanan
Other providers in Mineral Wells, WV
- Patsy Bee
- Teresa Ann Blake
- Joseph Stephen Blevins
- Erin Hudgins Branham
- Cody Cale
- Camden Clark Memorial Hospital Corporation
- Marilyn Sue Carmichael
- Amy Carter
- Kimberly Cline
- Daniela Christine Cochran
All providers in Mineral Wells, WV · Physical Therapist in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.