Provider Demographics
NPI:1730485376
Name:IVAN, FRANK EDWARD III (PT)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:EDWARD
Last Name:IVAN
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 BIG TIMBER RD
Mailing Address - Street 2:
Mailing Address - City:CAPON BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:26711-8943
Mailing Address - Country:US
Mailing Address - Phone:304-860-5366
Mailing Address - Fax:
Practice Address - Street 1:13857 APPLE HARVEST DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-6199
Practice Address - Country:US
Practice Address - Phone:681-248-5384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-30
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206758225100000X
WV004477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2307001197OtherDIRECT ACCESS CERTIFICATION
VAK949 - 0077OtherCAREFIRST