Provider Demographics
NPI:1770232332
Name:LUZARRAGA, JEANNE TRISHIA MANZANA (PT)
Entity Type:Individual
Prefix:
First Name:JEANNE TRISHIA
Middle Name:MANZANA
Last Name:LUZARRAGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2536
Mailing Address - Country:US
Mailing Address - Phone:304-712-6320
Mailing Address - Fax:
Practice Address - Street 1:405 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3143
Practice Address - Country:US
Practice Address - Phone:304-252-6317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist