Provider Demographics
NPI:1821506122
Name:RUMBAUGH, WILLIAM LOGAN
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LOGAN
Last Name:RUMBAUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-0451
Mailing Address - Country:US
Mailing Address - Phone:304-444-2076
Mailing Address - Fax:
Practice Address - Street 1:3450 MONONGAHELA BLVD.
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26507-0877
Practice Address - Country:US
Practice Address - Phone:304-444-2076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer