Provider Demographics
NPI:1487706719
Name:HATCHER, DEAN D
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:D
Last Name:HATCHER
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 1:1107 GREENMONT CIR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-3299
Mailing Address - Country:US
Mailing Address - Phone:304-295-0799
Mailing Address - Fax:
Practice Address - Street 1:3 WESTERN HILLS DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-8122
Practice Address - Country:US
Practice Address - Phone:304-420-1300
Practice Address - Fax:304-420-1374
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0002106000Medicaid
WV0002106000Medicaid