1669797395 NPI number — MOUNTAIN RIVER PHYSICAL THERAPY LLC

Table of content: (NPI 1669797395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669797395 NPI number — MOUNTAIN RIVER PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
MOUNTAIN RIVER PHYSICAL THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1669797395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 36TH ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26101-1005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-917-3660
Provider Business Mailing Address Fax Number:
304-917-3674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 E STATE ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701-2143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-593-6778
Provider Business Practice Location Address Fax Number:
740-593-7481
Provider Enumeration Date:
04/06/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
BURTON
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
304-865-6778

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)