Basic Information
| Provider Information | |||||||||
| NPI: | 1295478378 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTIAN | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3010 LAUREL FORK RD | ||||||||
| Address2: | |||||||||
| City: | CLENDENIN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250455326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045463707 | ||||||||
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| Practice Location | |||||||||
| Address1: | 332 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253031269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047579333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2022 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 000820 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.