1891806949 NPI number — PHYSICAL & OCCUPATIONAL THERAPY SERVICES INC.

Table of content: (NPI 1891806949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891806949 NPI number — PHYSICAL & OCCUPATIONAL THERAPY SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL & OCCUPATIONAL THERAPY SERVICES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRO 1 THERAPY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891806949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111B SANDERS LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUEFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24605-9278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-326-3611
Provider Business Mailing Address Fax Number:
276-322-2850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111B SANDERS LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUEFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24605-9278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-326-3611
Provider Business Practice Location Address Fax Number:
276-322-2850
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
ALLAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
276-326-3611

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X , with the licence number: 002567 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X , with the licence number: 2305202418 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2255A2300X , with the licence number: 050102053 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0156094000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0159770000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036077 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 054378 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".




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