Provider Demographics
NPI:1417432725
Name:STURM, KEVIN TAYLOR (PTA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:TAYLOR
Last Name:STURM
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 FOXCROFT AVE # 14
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-1838
Mailing Address - Country:US
Mailing Address - Phone:304-262-8161
Mailing Address - Fax:
Practice Address - Street 1:772 FOXCROFT AVE # 14
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-1838
Practice Address - Country:US
Practice Address - Phone:304-262-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002514225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant