Basic Information
| Provider Information | |||||||||
| NPI: | 1518446335 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RACE | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | THOMPSON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 HOLLEY CT | ||||||||
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| City: | BARBOURSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255041006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049429046 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 SEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HURRICANE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255269206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047576805 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2018 | ||||||||
| LastUpdateDate: | 08/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 002496 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.