Provider Demographics
NPI:1578903233
Name:HARDIMAN, CHEVELE ANN (LMT / HEALTH COACH)
Entity Type:Individual
Prefix:
First Name:CHEVELE
Middle Name:ANN
Last Name:HARDIMAN
Suffix:
Gender:F
Credentials:LMT / HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9598
Mailing Address - Country:US
Mailing Address - Phone:304-667-3331
Mailing Address - Fax:
Practice Address - Street 1:249 LAWN RD
Practice Address - Street 2:
Practice Address - City:MEADOW BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:25976-9260
Practice Address - Country:US
Practice Address - Phone:304-667-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
WV2010-2737225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist