Provider Demographics
NPI:1710356480
Name:GONZALEZ-BELCHER, AUTUMN (LMT)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:GONZALEZ-BELCHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 DUSTY MILLER ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-7666
Mailing Address - Country:US
Mailing Address - Phone:304-910-9880
Mailing Address - Fax:
Practice Address - Street 1:222 NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2135
Practice Address - Country:US
Practice Address - Phone:304-910-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2015-3335225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist