Provider Demographics
NPI:1831336932
Name:WALLEN, ELIZABETH P (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:P
Last Name:WALLEN
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 1:523 TEEL RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2349
Mailing Address - Country:US
Mailing Address - Phone:304-252-2650
Mailing Address - Fax:
Practice Address - Street 1:145 GEORGE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2607
Practice Address - Country:US
Practice Address - Phone:304-253-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-11
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0001312251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics