Provider Demographics
NPI:1760680094
Name:WEST, RAVEN V (DPT)
Entity Type:Individual
Prefix:DR
First Name:RAVEN
Middle Name:V
Last Name:WEST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 E WILDERNESS RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-8501
Mailing Address - Country:US
Mailing Address - Phone:601-445-8734
Mailing Address - Fax:
Practice Address - Street 1:1941 SAVAGE RD
Practice Address - Street 2:SUITE 400C
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4704
Practice Address - Country:US
Practice Address - Phone:843-571-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3625225100000X
TNPT 7678225100000X
SCPT 5250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist