Provider Demographics
NPI:1730698606
Name:STRAIGHT, DONNIE LEE III (LMT)
Entity type:Individual
Prefix:MR
First Name:DONNIE
Middle Name:LEE
Last Name:STRAIGHT
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 TERRACE MNR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-4249
Mailing Address - Country:US
Mailing Address - Phone:304-365-1136
Mailing Address - Fax:
Practice Address - Street 1:1900 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1293
Practice Address - Country:US
Practice Address - Phone:304-365-1136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-23
Last Update Date:2017-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2016-3427225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty